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D.C. Report: CMS Grants Quality Reporting Waiver for Hurricane-Sandy Area Providers

December 4, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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CMS to grant blanket hurricane-related quality reporting waiver The Centers for Medicare & Medicaid Services intends to waive certain quality data submission and validation requirements for hospitals in Connecticut, New Jersey, New York and Rhode Island counties designated “major disaster” areas for Hurricane Sandy by the Federal Emergency Management Agency, CMS announced recently.  A memorandum sent to quality improvement organizations outlined specific data submission and validation waivers being granted to providers who report under the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) “due to the devastating impact of hurricane Sandy.”  The blanket waiver currently applies only to the hospital inpatient and outpatient quality reporting programs, CMS said. Hospitals outside the designated counties may request an individual waiver using a process described in the memo, the agency said.

OIG Report Calls Attention to Possibility of Fraud, Abuse in EHR Incentive Payments The HHS Office of Inspector General issued a report recently finding that the EHR Incentive Payments program is “vulnerable” to fraud and abuse.  Investigators for OIG are concerned that CMS and ONC are not taking the proper measures to verify – prepayment – that hospitals and doctors are actually meeting the requirements of Meaningful Use.  “Although CMS’s prepayment validation functions correctly, it does not verify that self-reported information is accurate,” the report said, “…it does not verify that numerators and denominators…reflect the actual number of patients for a given measure or that professionals and hospitals possess certified EHR technology.”

OIG had several recommendations for both CMS, including:

·         CMS should begin a program of obtaining and reviewing support documentation from selected Eligible Professionals and Hospitals prior (emphasis added) to paying the EHRs incentive payment to verify accuracy

o   CMS did not agree with the recommendation based on a concern the recommendation will place undue burden on the professionals or hospitals and delay payments substantially

·         CMS should issue agency-developed guidance for Eligible Professionals and Hospitals that explains the types of documentation CMS expects should be maintained to support (or verify) eligibility for the Meaningful Use program.

Recommendations for ONC included:

·         ONC should require Certified EHRs Technology to be capable of producing reports for the “Yes/No Attestation” Measures “Where Possible”

·         ONC should require certifying bodies to use standard test data to determine EHRs are meeting the certification criteria.

For its part, CHIME issued the following statement:

CHIME appreciates the role of the HHS Inspector General and understands why the EHR Incentive Payments program has garnered attention from the OIG.  All of our member CIOs take very seriously the process of attesting to Meaningful Use and the legal obligations that come with it.  We strongly support the OIG recommendation that CMS develop and disseminate guidance detailing the types of documentation that Eligible Hospitals and Eligible Professionals need on hand to comply with audits.  CHIME was one of several co-authors in a letter to the Secretary asking for as much in the summer of 2011.

However, we do not believe it necessary that CMS collect documentation beyond attestation from hospitals and eligible professionals prior to sending payments.  We agree with CMS’s stated response to OIG that such an action would impose a significant delay on the payment process, causing an unnecessary and detrimental situation for providers.

CHIME will continue to monitor OIG activities as well as other oversight actions by the Congress.