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Visit the following page for information on Use Case 2 eMDR and Structured Content: UC 2 - eMDR and Structured Content
Visit the following page for information on the Harmonization of Use Case 2: Harmonization - UC 2
| Date | Artifact Name | Artifact Links |
| 5/30 | esMD Use Case 2 - Secure Transportation and Structured Content of Electronic Medical Documentation Requests (eMDRs) | Wiki Link Consensus Votes |
Click HERE to download printable PDF version of the Structured Content Workgroup Charter
The purpose of this workgroup is to investigate and recommend options to electronically send medical document requests to Providers from payer or payer contractors, as an alternative to the current process of physically mailing paper request letters.
Define the business requirements related to the medical documentation request letters process, and analyze and harmonize standards that can be used to electronically send standards-based medical document request letters. Business requirements and standards will have a key focus on the needs of CMS and the CMS post-payment Review Contractors, while also considering options to enable re-use by other Payers and Medicare partners.
Priority within the esMD Initiative:
High Priority - This is a basic requirement needed for the esMD Phase 2 targeted for Fall 2012.
In Scope (Revisions to these can be found in Use Case 2 - Sending and Structured Content of eMDR):
Templates/Datasets/Standards relevant to structure of electronic Medical Document Request (eMDR)
Basic requirements for the response to the medical document request letter: Although this workgroup will not define the structured content for the response to the MDR, the workgroup will consider potential requirements for the response, to ensure the structured medical document request letter provides all the information that will be reused in the response, in the relevant format.
To the extent that digital certificates for identity or encryption are required by this use case, coordination with the S&I Provider Directory workgroup should be considered.
Requirements and standards pertaining to secure sending of MDR letter to specific provider
Standards relating to registration of Providers with esMD
Templates/Standards relevant to Structured Inbound/Medical Documentation from Providers to CMS
Authentication of content sent from Providers (will be covered in the Author of Record workgroup)
In addition to the Medical Document Request letter, there are several other letters CMS Review Contractors send. Those formats will not be discussed in detail in this workgroup, but there will be the assumption/consideration that these standards could be reused on those letters.
HIPAA (45 CFR Parts 160 & 164)
42 CFR Part 2 (Confidentiality of Alcohol and Drug Abuse Patient Records)
Title 38
§ 5701 - Confidential nature of claims
§ 7332 - Confidentiality of certain medical records
HITECH Self-Pay Rule
45 CFR § 164.522(a)(1)(vi)
NPRM 45 CFR Pts 160 & 164 RIN 0991-AB57 (July 14, 2010) proposes to modify Section 13405 of the HITECH ACT (Restrictions on Certain Disclosures and Sales of Health Information; Accounting of Certain Protected Health Information Disclosures; Access to Certain Information in Electronic Format) through changes to § 164.522 which will allow patients to withhold any health information from payors for services they received and paid for out-of-pocket (except as prohibited by law), and also overrides the provision in § 164.522(a)(1)(ii) that the covered entity is not required to agree to requests for restrictions and requires that we modify the regulation.
TBD
Could have HIPAA relevance
Medicare partners, claims clearing houses providers, EMR vendors: If they comply with CMS, they could use this medical request letter format with each other
Within S&I: N/A
External to S&I: TBD - Need community input (HL7 Claims Attachments, CDA, NCVHS)
Within CMS: TBD
