OIG to CMS: Get tougher on EHR incentive verifications

The meaningful use incentive program for electronic health records (EHRs) need stricter validation processes, and the current system of provider self-reporting is not enough, says Inspector David Levinson of the Office of Inspector General (OIG).

The currrent processes leave the Centers for Medicare & Medicaid Services (CMS) “vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the OIG noted in the year-one assessment report of the programs. 

The OIG advised CMS to implement stiff prepayment safeguards, including requiring specific types of documentation as proof of qualification for the incentive payments and conducting reviews of the qualifications before payments are issued.

Currently, meaningful use accomplishments are self-reported into the National Level Repository (NLR), the CMS database for the EHR program. Although the NLR database performs certain system checks on the data to validate data entry prior to payment, CMS oversight needs to be tightened and reinforced through significantly better prepayment verification of self-reported data and through post-payment audits, the report suggests.

The Office of the National Coordinator for Health Information Technology (ONC) may need to amend its processes, too; ONC’s current requirements for EHR reports don’t include the 19 yes/no measures. “CMS cannot use EHR reports to verify all self-reported meaningful use information because ONC does not require certified EHR technology to be capable of producing reports for all meaningful use measures. ONC requires only that certified EHR technology be capable of producing reports covering professionals’ and hospitals’ performance on the 30 percentage-based meaningful use measures,” the report notes.

The OIG’s report included a review of data from 26,653 professionals and 668 hospitals who applied to the program during May–December 2011, totalling about $1.7 billion in payments. Through the incentive program, CMS expects to have awarded $6.6 billion in incentive payments by 2016.

Topics: Accountable Care Organizations (ACOs) , Medicare/Medicaid , Regulatory Compliance , Technology & IT