PRIA, Government Policy, Made Personal

Summary

Each year, starting in 2015, the Secretary must put easy-to-understand public data online about doctors and other eligible professionals and the services they gave to Medicare patients. The data must be like the 2012 Medicare Provider Utilization and Payment Data file and shown the same way. At a minimum it must list how many services a provider gave (including common services or groups), the charges submitted and payments made, and a public unique ID (for example a national provider identifier). The data must be searchable by specialty, by service features (such as volume or groupings), and by location. Starting in 2016, the information must be added to the Physician Compare website. The terms "eligible professional," "physician," and "Secretary" use the meanings given in section 1395w–5(i); "Physician Compare" means the CMS Physician Compare website (or a successor).

Title 42, §1395w–6

The Public Health and Welfare, Source: USLM XML via OLRC

(a)On an annual basis (beginning with 2015), the Secretary shall make publicly available, in an easily understandable format, information with respect to physicians and, as appropriate, other eligible professionals on items and services furnished to Medicare beneficiaries under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(b)The information made available under this section shall be similar to the type of information in the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File released by the Secretary with respect to 2012 and shall be made available in a manner similar to the manner in which the information in such file is made available.

(c)The information made available under this section shall include, at a minimum, the following:

(1)Information on the number of services furnished by the physician or other eligible professional under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), which may include information on the most frequent services furnished or groupings of services.

(2)Information on submitted charges and payments for services under such part.

(3)A unique identifier for the physician or other eligible professional that is available to the public, such as a national provider identifier.

(d)The information made available under this section shall be searchable by at least the following:

(1)The specialty or type of the physician or other eligible professional.

(2)Characteristics of the services furnished, such as volume or groupings of services.

(3)The location of the physician or other eligible professional.

(e)Beginning with 2016, the Secretary shall integrate the information made available under this section on Physician Compare.

(f)In this section:

(1)The terms “eligible professional”, “physician”, and “Secretary” have the meaning given such terms in section 1395w–5(i) of this title.

(2)The term “Physician Compare” means the Physician Compare Internet website of the Centers for Medicare & Medicaid Services (or a successor website).

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsecs. (a) and (c)(1), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XVIII of the Act is classified generally to this subchapter. Part B of title XVIII of the Act is classified generally to this part. For complete classification of this Act to the Code, see section 1305 of this title and Tables. Codification Section was enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015, and not as part of the Social Security Act which comprises this chapter.

§1395w–6 Empowering Beneficiary Choices Through Continued Access to Information on Physicians’ Services

Summary

Title 42, §1395w–6

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata