A “Qualified Entity or QE” is an organization approved by the Centers for Medicare & Medicaid Services (CMS) to produce performance reports on the quality and efficiency of health care providers and suppliers. The QE program was authorized by the Patient Protection and Affordable Care Act (ACA) to encourage provider performance measurement and public reporting using Medicare claims data and private payer claims data (e.g. health care billing information that is submitted for reimbursement. As of April 2014, there are 12 certified qualified entities throughout the country. These approved QEs have combined Medicare data with claims data from other sources (such as Medicaid and private insurance data) to create public reports on the performance of providers in their regions.
To learn more about the Qualified Entity program, including how QEs can use Medicare claims data, we invite you to read our Fast Facts and Myth Buster by clicking on the links below.
Fast Facts: What is a Qualified Entity?
Myth Buster: Qualified Entities can use Medicare claims data for commercial purposes.
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