GAO: Doctors should submit more data to get meaningful use money

Physicians soon could be required to submit more documentation to the Centers for Medicare & Medicaid Services to validate whether they are authorized to receive meaningful use bonuses.

Saying that the Medicare incentive program is vulnerable to making improper payments, the Government Accounting Office examined the process, called attestation, that CMS uses to validate whether physicians have met meaningful use requirements. The agency recommended that CMS examine its process for auditing the incentive program and collect more information from physicians before payments are made so they won’t have to return money to CMS.

“It is more effective and efficient to prevent improper payments than to detect and recoup them later,” wrote Linda Kohn, director of the GAO’s health care team and author of the GAO report.

Though neither the report nor CMS placed a deadline on when the recommendations should be implemented, CMS agreed that its process for verifying meaningful use eligibility could be made more efficient for the agency — and more stringent for those applying for incentive pay.

The Medicare incentive program is facilitated directly by CMS, and the Medicaid incentive program, like the Medicaid program, is administered at the state level. The GAO examined the eligibility and reporting requirements for the Medicare program, and the reporting and verification processes in four states that have a Medicaid incentive program up and running. As of March, 44 states had programs in place, and 40 had begun issuing incentive checks.

What needs verification

Medicaid requires additional reporting that Medicare either does not require or does not verify until after payment is made. The GAO would like to see the Medicare requirements expanded to match those of Medicaid.

One example is that to meet the requirement that data be sent electronically to an immunization registry or immunization information system, Medicaid program participants must submit the name of the registry where they sent data and whether it was sent successfully. Medicare participants are required only to attest that it was done.

“While CMS officials recognize that the Medicare EHR program could benefit from taking steps to collect similar information from Medicare providers, the agency has not yet done so,” Kohn wrote.

Joseph Kuchler, CMS press officer, said the agency agreed with the GAO’s recommendation to investigate changes it may need to make, but that it’s too soon to tell what the changes might entail.

CMS also agreed that it needed to evaluate its auditing process to ensure its effectiveness. Kuchler said its auditing program is being implemented and that a contract was recently awarded. It plans to start audits later in 2012.

About 10% of hospitals and 20% of professionals receiving incentive checks will be selected at random for auditing. Some also will be targeted for audits. Physicians who received improper payments would have to return the money to CMS.

Kuchler said whatever CMS does with the GAO recommendations, it “is conscious of not adding unnecessarily to the burden providers face in reporting for this program and will certainly factor in the element of additional time in its determinations as we move forward.”

The American Medical Association and 98 state and specialty societies submitted comments to CMS in May in response to the drafting of the meaningful use program’s stage 2 requirements that suggest CMS’ measures would burden physicians.

Among the GAO’s recommendations was for CMS to offer to collect quality measure data from Medicaid program participants on behalf of the states. But CMS rejected that recommendation, saying the states that have launched incentive programs already have portals in place and that there are no significant barriers to states collecting this information on their own.