OIG approves referral arrangement involving EHR data exchange

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The U.S. Department of Health & Human Services' Office of Inspector General (OIG) has given the green light to a proposed arrangement that would allow providers' medical data stored in their electronic health records to be shared for the purpose of referring patients to each other.

OIG's advisory opinion, posted on its website Dec. 7, would allow the company requesting the opinion--which offers web-based EHRs and other products, but whose name was redacted for confidentiality purposes--to introduce a "Coordination Service" to facilitate the exchange of information between providers and help them keep track of patients receiving services from others.

The service would be offered only to providers who utilize the company's EHR service. It would help providers who wish to make patient referrals by electronically sending medical, billing and other records of a patient when seen by other providers, issue referral recommendations, track communication and exchange information from the EHRs on orders and results. The requesting company intends to create a database of providers derived from its EHR service and other available databases of healthcare professionals.

Providers who sign up for the coordination service would receive a 25 to 35 percent discount on the monthly subscription fee for the EHR service. There also would be transaction-based fees.

OIG stated that while the arrangement doesn't meet the referral "safe harbor" in the Anti-Kickback Statute, it would not subject the company to sanctions under the statute, since, among other things were was no payment requirement to be included in the database, the transaction fees are fair market value, and they're not tied to whether the patient follows through and sees the referred provider.

"The efficient exchange of health information between health professionals is a laudable goal," the OIG stated.

The agency noted that the opinion applies only to the requesting company. However, it does provide unofficial guidance on how OIG may view similar arrangements.

To learn more:
- read the advisory opinion (.pdf)

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