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cms patient access rule

Managing the CMS Patient Access Rule with ZeOmega and EHNAC

The CMS Patient Access Rule – Enhancing Patient Access and Interoperability

Patient Access and Interoperability bring hundreds of payers and app developers into an emerging ecosystem that will continue to mature. The steps outlined in the CARIN guide can help payers manage the CMS Patient Access Rule, although the process may seem overwhelming to navigate unassisted. Today, there are several technological resources at payers’ disposal to help them navigate to compliance and sustainability through the emerging interoperability ecosystem.

ZeOmega and the Security and Interoperability Trifecta

ZeOmega, for example, has developed technological frameworks and implemented use cases that support payer requirements specified within relevant CMS rules, while also investing in the registration and testing certifications described in the previous blog.

ZeOmega is also the first population health management organization to have passed all three comprehensive data security and interoperability testing programs, known as the “Security and Interoperability Trifecta”:

  • HITRUST’S Common Security Framework (CSF) certified status for information security
  • The Drummond Group’s Payer and Patient Access Fast Healthcare Interoperability Resource API certification for FHIR standards conformance
  • EHNAC’s Comprehensive TDRAAP accreditation. TDRAAP combines the technical framework using Unified Data Access Profiles (UDAP) in a FHIR ecosystem with interoperability-related privacy and security requirements.

Combined, these certifications represent the top testing programs for healthcare data security and interoperability in the United States and certify the highest standards of information safety and security.

The Need for Secure Patient and Payer Access

The rise of cyberattacks and ransomware risks has made healthcare data and systems security more critical than ever. Additionally, safe and secure data exchange is important for accomplishing goals in terms of compliance, risk mitigation and providing high-quality, value-based care as well as patient confidence and adoption.

HealthUnity’s Approach to FHIR-Based Interoperability

HealthUnity also offers a FHIR-based interoperability gateway facilitating payer compliance with the Patient Access API, Provider Directory API and Payer-to-Payer Data Exchange requirements of the CMS Patient Access and Interoperability Final Rule, as well as:

  • Native integration with Jiva that enables streamlined access to information payers must provide.
  • Plug and play connectivity to other relevant data sources such as claims systems and data warehouses.
  • Investment in FHIR-based interoperability frameworks that help ensure accelerated, cost-effective implementations for clients.

In addition to addressing compliance requirements and data formats, HealthUnity helps payers capitalize on their investment by maximizing the value of the data being exchanged. The capabilities in HealthUnity also support enriched data exchange with other payers, as well as with providers and community services organizations. This facilitates greater continuity of care across clinical and social determinants of health.

Third-Party Assessments for Security and Interoperability

Opting for independent third-party privacy and security assessment through EHNAC TDRAAP accreditation would be another way for client apps and servers to voluntarily signal a strong security posture and protection of member privacy. Given that HealthUnity has already secured this accreditation (along with HITRUST and Drummond), the solution offers payers a more efficient way to meet their compliance requirements and go beyond the mandates to differentiating capabilities as the interoperability ecosystem expands.

Take the Next Step Toward Interoperability and Security

ZeOmega stands ready to support our payer clients in meeting the aggressive timeframes specified by interoperability regulations. HealthUnity is the first interoperability solution to achieve TDRAAP accreditation and Drummond certification. Having both these credentials coupled with HITRUST certification separates HealthUnity from all other platforms on the market—proving it to be a leader for interoperability, security, functionality and value. To learn more, contact a ZeOmega expert at sales@zeomega.com or 214.618.9880.