EDITOR’S NOTE: In an earlier version of this article, which has since been corrected, two inaccuracies were noted. TEFCA was introduced by the U.S. Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) not the Centers for Medicare & Medicaid Services, and TEFCA does not certify QHINs, but rather conducts evaluations. RACmonitor apologizes for the errors.
I recently saw a notable update on the Trusted Exchange Framework and Common Agreement or TEFCA, a federal program intended to improve health data interoperability across the healthcare industry.
It made me think about how quickly healthcare interoperability is advancing.
Interoperability touches nearly all stakeholders in the industry, most especially providers, and TEFCA’s nearly weekly developments are rapidly shaping the future of healthcare.
So, here’s a quick refresher on TEFCA, its status, and why it’s worth keeping an eye on.
The exchange of health information is crucial for delivering efficient and effective patient care. However, as you may know, interoperability challenges have hindered smooth data exchange among healthcare providers, which causes fragmented care and compromised patient outcomes.
To address these issues, TEFCA was introduced by the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT, or the ONC.
At its core, TEFCA is a set of principles and requirements for secure information-sharing among health information networks across the U.S., and it serves as an outline for establishing a common set of principles, terms, and conditions for the trusted exchange of electronic health information.
TEFCA’s outline of fundamental principles for achieving interoperability includes those for data standardization and privacy protections. TEFCA’s contracted Recognized Coordinating Entity (RCE) also evaluates health information networks for potential designation as TEFCA QHINs, or Qualified Health Information Networks, across the country, responsible for facilitating health information exchange among healthcare organizations.
Several key phases have shaped TEFCA’s trajectory, including pilot testing of the program’s concepts and functionalities, engaging stakeholders to ensure alignment with diverse needs and perspectives, and, since TEFCA intersects with existing regulations such as the 21st Century Cures Act and the Healthcare Insurance Portability and Accountability Act (HIPAA), it compels the streamlining of regulatory requirements and integration into the broader healthcare landscape.
Most recently, the ONC announced updates to TEFCA’s Common Agreement, which establishes the technical infrastructure and governing approach for QHINs and their users to securely share clinical information with each other.
The updates allow QHINS to begin the process of employing FHIR standards to meet data exchange requirements, serving as yet another example of the federal governments’ intent to move toward FHIR standards on many fronts in healthcare.
You may recall that CMS recently gave a nod to FHIR standards for use in generating the Advance Explanation of Benefits (AEOBs) and Good Faith Estimates (GFEs) that stem from the No Surprises Act. Further, health plans serving the Medicare, Medicaid, and Patient Protection and Affordable Care Act (PPACA) marketplace populations are already required to use FHIR standards for certain data exchange functions.
Not only does TEFCA represent a revolutionary initiative to promote nationwide interoperability and enhance health information exchange, but it also stands to be a key driver of impending interoperability efforts between payors and providers.
What’s more, it holds immense potential to revolutionize healthcare delivery, improve patient outcomes, and steer innovation across the healthcare ecosystem by enabling patient information to move quickly and seamlessly across the country, facilitated by local QHINs, moving patient data to the appropriate providers for continuous patient care and, most importantly, getting that same patient data in the hands of patients themselves.
Something with such sweeping implications for healthcare professionals, like many of you, is sure to make big waves. Arm yourself with awareness now.
TEFCA is paving the way for a more connected and patient-centric healthcare system. I suggest taking a look at the ONC’s website for more on TEFCA and its latest progress.
Since Jan. 20, it seems that uncertainty in healthcare has become the new normal. After a contentious hearing, Robert F. Kennedy, Jr. was appointed to
The U.S. Department of Health and Human Services (HHS) has recently made a declaration to cease the public comment period for their proposed regulations. By
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
