Program risks paying incentives to professionals and hospitals that do not meet meaningful use standards.
Health care providers should do more to prove that their electronic health records meet meaningful-use standards, says the Health and Human Services Department inspector general.
In a report issued Wednesday, HHS IG Daniel Levinson said the information providers submit to the Centers for Medicare and Medicaid Services lacks validation. As such, the Medicare EHR incentive program is “vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements.”
CMS lacks “strong prepayment safeguards, and its ability to safeguard incentive payments post-payment is also limited,” according to the report.
Prepayment verification involves double-checking the numbers in providers’ reports, but not validating whether the core information is true, according to the findings. That’s because there’s no requirement for providers to submit documentation supporting the numbers in their reports. CMS can conduct post-payment audits, but it has not yet done so.
The IG suggested that conducting spot risk analyses by requesting documentation from a subset of providers could give CMS a truer picture of compliance. Using one of the risk analyses CMS has proposed to identify candidates for post-payment audits could have identified 14 percent of professionals and 17 percent of hospitals for possible review, the IG found.
The Office of the National Coordinator for Health Information Technology also came in for criticism. ONC could help CMS with verification by requiring that EHR certification bodies comprehensively test EHR reports for accuracy, and by updating its regulations to include reporting functions, according to the report.
The IG’s office recommended that CMS:
- Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information.
- Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.
CMS responded by saying that prepayment reviews would “increase the burden on practitioners and hospitals and could delay incentive payment.” CMS agreed that there is a need to issue guidance with examples of documentation.
The report also recommended that ONC:
- Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible.
- Improve the certification process for EHR technology to ensure accurate EHR reports.
ONC concurred with those recommendations.