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Medicaid and The Need For More Interoperability?


Medicaid and The Need For More Interoperability?
Medicaid and The Need For More Interoperability?


>> Medicaid and The Need For More Interoperability?


The Centers For Medicare and Medicaid Services (CMS) have always been on the frontlines to work with the government to promote interoperable healthcare practices. They have been primarily concerned with how revolutionizing healthcare IT can boost patient engagement and make healthcare more effective. At the center of the state’s efforts for interoperability is the patient and ensuring they can avail themselves of the best healthcare experience.


What Is Interoperability?

Interoperability is when different devices, programs, apps, and operating systems exchange information or data seamlessly and efficiently. These operating systems access, exchange, integrate, and use this data differently. It is also helpful for these computer systems to store information in one place and incorporate various formats into one readable interface.


The Main Benefits of Interoperable Healthcare

Some of the main benefits that interoperability brings to healthcare are as follows:


  • Since patients go to many doctors for medical care, interoperability helps compile their entire medical data into one place. This data is easily accessible to the doctor they go to, and they can even make real-time changes to it or update it so that other doctors are kept in the loop.

  • It makes medical data sharing more transparent and accountable. The CMS guidelines ensure that all medical service providers provide access to patients’ medical records when requested, or they will be labeled as outliers. This helps patients and payers understand the medical procedure better and know what they're being charged for.

  • Healthcare becomes more efficient and effective when it is easier to manage and practice. The immense strain on doctors and care providers is drastically reduced through interoperability efforts to ensure better work productivity and efficiency. This leads to overall better care practices.


Medicaid’s Efforts For More Interoperability

For the last few years, the government has directed Medicaid to make it easier for patients to access their healthcare information. This is being done under the ‘Interoperability and Patient Access Final Rule’ to be implemented for Medicaid and Children’s Health Insurance Programme.


Since 2016, Medicaid has been undergoing efforts to boost interoperability between different Medicaid service providers. Some challenges have been bringing all of the Medicaid service providers into the loop and connecting providers from different states to each other.


The main focus was to develop software that can carry messaging and connectivity channels between different EHRS and create interoperable IT products. Patients benefitting from Medicaid services can access their medical information through selected apps that send requests to data exchange to these EHRS.



Medicaid’s Compliance With CMS’s Policies

CMS has issued guidelines for Medicare that had to go into effect from January 1st, 2022. Some of these guidelines were as follows:


  • Medicare is to ensure payer-to-payer data exchange so that a patient’s data can be transferred from one payer to another.

  • They must consider the regulations when implementing the API.

  • Work on any further documents and contract amendments that have to be made to include interoperability in Medicare services.

  • To address any funding or data infrastructure issues and work with the CMS Medicaid Enterprise System to address them.

  • Understand and create the appropriate sets of patient information data to be stored or exchanged between different systems.


The Way Forward

The implementations of these guidelines are still underway. However, Medicaid has come a long way in implementing interoperability standards. Patients will now be able to view their medical history and other information related to Medicaid service providers. In short, it will help Medicaid become more effective in providing healthcare services to the people.




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DevScripts Solutions is an IT Consultant Firm Specializing in Interoperability within the Healthcare Arena.


We are a small team solving big interoperability challenges on a daily basis. With our vast knowledge of interoperability we can integrate ourselves as part of your organization just like we are part of your full-time team. We develop a variety of custom interfaces for healthcare organizations such as Healthcare Vendors, HIEs, Health Systems, Hospitals, Medical Practices, Payors and ACOs using Mirth Connect.


We work with businesses in California, Georgia, New York, Florida, Texas and throughout the wider United States.


For more information on our services or to arrange a consultation call please contact us today.

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