CMS rolls out MACRA information-blocking attestation requirement to support EHR interoperability

New guidance issued by the Centers for Medicare & Medicaid Services (CMS) explains how physician practices will need to attest that they are not engaged in information blocking in order to receive quality payments under MACRA.

CMS will require MIPS-eligible clinicians to complete a “Prevention of Information Blocking Attestation" to receive a score for advancing care information performance under the Quality Payment Program. Clinicians who have elected to report under MACRA’s Merit-based Incentive Payment System (MIPS) will have to attest that they have not "knowingly and willfully limited or restricted the compatibility or interoperability" of certified EHR technology (CEHRT), according to a CMS fact sheet (PDF).

The attestation requires a “good faith” attempt to exchange electronic health information in the context of a given clinician’s practice size and technology, without holding clinicians responsible for circumstances beyond their control.

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The attestation requires clinicians to make three separate statements:

  • That they have not acted “knowingly and willfully” to restrict their CEHRT’s compatibility or interoperability.
  • That their CEHRT has been implemented to comply with applicable laws and standards. These include criteria adopted under federal law with regard to technological specifications. CEHRTs must also be implemented to allow patients timely access to their own health information, as well as “trusted bi-directional exchange of structured electronic health information with other healthcare providers.”
  • That they respond “in good faith and in a timely manner” to any and all appropriate requests for healthcare information, whether from patients, providers, or other individuals.

Information blocking is a central part of the 21st Century Cures Act, which calls on the Office of the National Coordinator for Health IT to define the practice. The Office of Inspector General is tasked with issuing fines to providers or vendors that engage in information blocking. 

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CMS notes that it does not expect clinicians to have specialized knowledge or skill, but the agency does expect physicians to ensure that those developing their technology understand the need to avoid restricting compatibility or interoperability of the system. The guidance document also points out that restricting functionality or access to information for system maintenance or in response to security concerns would not prevent clinicians from attesting that they have met the requirements.

While the attestation forms the basis for the advancing care information performance category, MIPS-eligible clinicians or groups must also use CEHRT, submit a performance period, meet base score measure requirements, and attest that they will work in good faith with an ONC direct review if requested to assist in one.