It seems like officials at the Centers for Medicare and Medicaid Services are always announcing a new audit plan or a crackdown on Medicare providers. But on Nov. 29, the agency found itself in hot water with the Office of Inspector General for the Department of Health and Human Services for being too fast to send payments to physicians and hospitals.
At issue is the CMS oversight of the Medicare electronic health record (EHR) incentive program and the $6.6 billion in bonus payments that the agency expects to hand out to physicians, hospitals, and other health care providers between 2011 and 2016. The program, which was authorized by Congress in 2009 and kicked off in 2011, gives physicians a chance to earn up to $44,000 in incentives for the meaningful use of EHR technology. Physicians can’t just buy an EHR; they have to choose a certified system to meet and report on quality metrics. The program has left some physicians frustrated by what they see as confusing criteria and a too-quick progression to more requirements.
©Brian Jackson/iStockphoto.com
But a new report from the Office of Inspector General (OIG) found that the way the CMS is administering the meaningful use program could leave the agency open to fraud by providers. The OIG looked at how the CMS performed in 2011, the first year in which payments were made under the program. The first problem flagged by the OIG was that the CMS pays out incentives based on self-reported data, but doesn’t verify the information before paying. In fact, in many cases, the agency doesn’t even have access to the information it would need to check what’s being reported. And doctors and hospitals aren’t required to submit supporting documentation when they attest to their meaningful use.
The CMS does plan to conduct postpayment audits, though the OIG report does not review those since none had been conducted to date. Under the CMS audit plan, the agency would review supporting documentation and reports created by the physician or hospital’s EHR. But the OIG raised concerns with the audit plan too. For instance, certified EHRs aren’t able to produce reports on all of the meaningful use measures, and there have been instances of EHRs producing inaccurate reports due to glitches in the systems.
The OIG recommended that the CMS require certain high-risk professionals and hospitals to submit supporting documentation to back up their meaningful use claims before getting paid. But in comments on the report, the CMS officials said they had no plans to make that change. They wrote that asking for more documentation could slow down payments and create additional burdens for providers, something they were unwilling to risk.
The agency did agree to make other changes aimed at safeguarding the incentive payments, including issuing better guidance on the type of supporting documents physicians and hospitals should keep in case of an audit.
So the next time you perform your meaningful use attestation, remember it could be worse.