New Report Calls for Greater Oversight of EHR Incentive Payments

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Posted By: Roberta Mullin November 29, 2012

OIG Finds Obstacles in Overseeing EHR Incentives

Established in 1976, the Health and Human Services (HHS) Office of the Inspector General (OIG) fights waste, fraud and abuse to over 300 HHS programs including Medicare, Medicaid, CDC, NIH, and FDA. Today OIG released a report that makes clear the need to tighten oversight of the Medicare EHR incentive payment program administrated by CMS.

Early Assessment Finds That CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program is based on a review of CMS’s oversight of eligible professionals and hospitals that self-reported meaningful use of certified EHR technology in 2011. As part of compiling this report, the OIG also reviewed CMS’s audit and regulation protocols.

Key findings from the report fall into pre and post-payment activities:

CMS does not verify the accuracy of the meaningful use information self-reported by eligible professionals (EPs) and eligible hospitals (EHs) prior to payment.

    • CMS’s prepayment validation functions correctly but does not verify the accuracy of self-reported information
    • Sufficient data are not available to verify self-reported information through automated system edits
    • CMS does not collect supporting documentation to verify self-reported information prior to payment

CMS’s planned post-payment audits may not conclusively verify the accuracy of the meaningful use information self-reported by EPs and EHs.

    • Reports from certified EHR technology are not sufficient for CMS to verify self-reported information and may not always be accurate
    • CMS may not be able to obtain sufficient supporting documentation to verify self-reported information during audits

The report makes a number of key recommendations to CMS and ONC to shore up oversight of the program.

  1. CMS direct select high-risk EPs and EHs to submit documentation supporting their self-reported meaningful use information for prepayment review.
  2. CMS bolster its current guidance for detailing the types of supporting documentation it expects EPs and EHs to maintain for meeting meaningful use measures.
  3. Require certified EHR technology be capable of producing Yes/No reports for meaningful use measures. The report suggests ONC update its current standards and functionality required for certified EHR technology or require this capability in future regulations.
  4. ONC improve the certification process of EHR technology with comprehensive standardized testing of the accuracy of EHR reports rather than rely on vendor-supplied test data.

Read the full OIG report here.