Health system leaders face challenges in exchanging patient data due to CMS regulations requiring broader data sharing, while privacy concerns mount from recent security breaches.
Additionally, third-party payer requests for clinical data are increasing. Although payers are authorized to access data for treatment, payment, or operations (TPO) under HIPAA, the minimal necessary rule still applies. To address these issues, some healthcare organizations are granting payers direct access to Electronic Health Records (EHRs), aiming to reduce administrative burdens and costs.
However, this practice can lead to unintended consequences, such as higher denial rates and unauthorized access to protected health information (PHI). Through this brief, MRO, in partnership with the College of Health Information Executives (CHIME) and Healthcare Financial Management Association (HFMA), examines the pros, cons, and real-world experiences of sharing clinical data with payers, offering insights for leaders in revenue cycle management, finance, IT, compliance, and health information management.
Read the full “Fast Focus: Payer Direct Access to Provider EHRs” below.
