Digital Contact Information into NPPES
Releasing Eight Clinical Note Types
What is Information Blocking?
In the 21st Century Cures Act, The Office of the National Coordinator (ONC) for Health Information Technology (HIT) released requirements regarding the prevention of “information blocking.” Information blocking refers to anything that restricts sharing and accessing electronic health information (EHI) among physicians and patients. Physicians have until April 5, 2021 to comply with certain provisions related to information blocking. The initial deadline was in November 2020, but due to COVID-19, an extension was granted.
The benefits of these information blocking provisions:
Note: Physicians with paper records are exempt from the information blocking requirements since this only involves electronic patient health information.
Requirement: Upload Digital Contact Information into NPPES
Physicians must have their digital contact information (direct address and/or an Application Programming Interface endpoint) from electronic health records listed in National Plan and Provider Enumeration System (NPPES). The direct address is not the same thing as an email address but looks very similar to one (ex. B.firstname.lastname@example.org). To learn more about a direct address, refer to the Direct Address Q&A.
How to Meet this Requirement
- Find direct address or API endpoint by contacting the EHR vendor, HIE, or another certified entity with direct messaging capability, such as a Health Information Service Providers (HISPs).
- Login to NPPES with User ID and Password to upload this information.
Enter direct address or API endpoint in a field for the digital contact information in a section related to Health Information Exchange.
are no penalties at this time for noncompliance. However, this requirement
needs to be completed immediately, as CMS will publicly report a list of
physicians who have not complied at the end of the first quarter.
Requirement: Starting April 5th, patients and physicians need to be given immediate electronic access to
significant portions of the patient’s electronic health information upon request.
should be able to access the eight types of clinical notes in their patient portal.
In the future, it is anticipated that ONC will require “open notes”. This means
that providers would be required to automatically release all clinical notes
when requested, and not just these eight note types. As ONC continues to move
towards EHI transparency, physicians should prepare for “open notes” if they
are not already releasing them.
How to Meet this Requirement
comply, physicians and practices should:
with their EHR vendor about their capabilities to allow the release of the eight
clinical note types in the patient portal to ensure that patients can access
EHR vendor has a plan in place to distinguish these 8 clinical note types and
other EHI in the EHR for purposes of responding to EHI requests.
how EHR vendor will help determine and document the use of exceptions (see
“Exceptions” section below).
- Evaluate whether existing practice policies about accessing EHI reflect the ONC Final
Rule requirements and ensure that the practice staff understands how to
approach EHI requests.
penalties for noncompliance will be decided in future rulemaking. ONC has the
functionality on its website to report information blocking.
soon as the physician’s office receives an electronic copy of results and
reports, these notes must be available to patients. However, there are eight
exceptions that offer healthcare providers certainty that when their
practices meet the conditions of one or more exceptions, such practices will
not be considered information blocking. For example, a physician who withholds a medical record to protect a patient from harm would not be considered information blocking.
to this resource for Information Blocking
set by the Office of the National Coordinator for Health Information Technology
- 2-page Fact Sheet on
- Action Steps Toolkit (MGMA)
- Part 1: What is
- Part 2: How do I comply
with info blocking and where do I start? (AMA)
- Cures Act Final Rule
- Information Blocking
- Cures Act Resource Center (TMA)
- Information Blocking Center (CHIME)
- TMA Article on Releasing Clinical Notes Requirement (TMA)
- TMB's Rule on Charging Fees for Medical Records Release (TMB)
- If patients ask for copies of their electronic protected health information (PHI), the fees you charge must be reasonable and cost-based, according to federal and state regulations.
- Board rules define reasonable fees of no more than $25 for the first twenty pages and $0.50 per page for every copy thereafter for providing paper copies, no more than $25 for 500 pages or less and $50 for more than 500 pages for copies in electronic format, and no more than $8 per copy of an imaging study. A physician may not charge a fee for a medical or mental health record if the request is related to a benefits or assistance claim based on the patient's disability.
- A “reasonable” copy fee may include only the costs associated with: Copying and labor (including compiling, extracting, scanning, burning onto media, and distributing media), Cost of supplies for electronic media, Preparing a summary of the records (when appropriate); and Postage (if the requestor wants the copy or summary mailed).