More oversight is needed for the new Medicare Electronic Health Record (EHR) program, according to a report from the Health and Human Services’ (HHS) Office of the Inspector General (OIG).
The program started in 2011 under Center for Medicare and Medicaid (CMS) studies and disbursed about $1.7 billion in its first year. CMS estimates that they will pay a total of $6.6 billion in incentive payments throughout the life of the program, which goes through 2016. More information on the program can be found here.
The report found that, while cursory checks were done to ensure eligibility in the program, the program mostly operates by applicants self-reporting. The model can work, but there was not enough verification done to ensure that the self-reported data was correct. The report stated that CMS “does not verify that… percentage-based measures [reported] reflect the actual number of patients for a given measure, or that professionals and hospitals possess certified EHR technology.”
Specifically, CMS has not yet done any post-payment audits, and they do not have a system in place to assess a potential recipient before a payment is made. Part of the issue may be the limited information that is included in reports that are collected by the Office of the National Coordinator for Health Information Technology (ONC) and shared with CMS.
As a result, the OIG report suggested that CMS set up a pre-payment verification system, where they obtain supporting documentation from applicants, and that they provide guidance and specific examples of what would represent acceptable supporting documents from applicants.
The CMS Acting Administrator Marilyn Tavenner responded to the report, saying that pre-payment audits were not necessary. She contends that these audits would only slow down the process and delay incentive payments, but she agreed with the need for CMS to provide more guidance on documentation.
The report also suggested that ONC improve their reporting and certification programs for EHR technology so they can verify information that CMS is getting from applicants.