Auditors Share Concerns Over Medicare Record Keeping and Auditing

healthcare_it_costThe Medicare and Medicaid Services is likely to pay out $6.6 billion between now and 2016 in an attempt to standardise their Electronic Health Records. They have outlined plans to enforce self-verification of CMS “meaningful use” standards for all the records kept by Medicare service providers. However auditors have raised concerns that there is no provision within the plans to actually ensure that each provider will be able to reach the necessary record keeping standards.

The systems in place are important to the aid that American’s receive, and if providers are either unable or unwilling to maintain the correct records – according to the Inspector General at the Health and Human Services Department – the entire Medicare program will suffer. The computer system for maintaining Electronic Health Records was developed using federal subsidies and the record keeping is an ongoing national issue.

Auditors have stated that the verification of these electronic records is hampered by the lack of data sources for meaningful measures and the fact that the Office of the National Co-ordinator for Health Information Technology does not issue certification to actually ensure providers are complying with the EHR standards.

The CMS could tackle this issue by being more selective of the providers it uses. They plan to carry out post payment auditing for the way providers use the system but they have not been clear enough about what documentation the providers should actually be keeping. It may include recording screenshots but auditors argue that this may not be sufficient verification for measuring drug-drug allergy interaction, one clinical decision support rules and drug formulary checks.

The auditors say these measures “may be particularly vulnerable to noncompliance” because they are carried out through clinical decision frameworks which the physicians already find “onerous” and “unnecessary.” The screen shots themselves only capture a brief instance during the process and will never give enough information for the CMS to check that the providers are actually using the clinical support tools that they should be.

Auditors have recommended that the Office of the National Co-ordinator for Health Information Technology begin issuing specific conditions for certification for all Electronic Health Records. Without this level of pre-agreement it is unlikely the  Medicare and Medicaid Services are going to be able to gather data on the meaningful use of the new systems. The CMS have also been advised to improve all of the supporting documentation that comes with the electronic systems and to offer better guidance to any provider who is part of Medicaid.

Once these measures are in place it may finally be possible for the American public to benefit from the enormous federal investment in this expensive Electronic Health Record system. The system is there to improve the care offered to American citizens but if it is not used in the proper way it could, according to this recent audit, damaging the care that is offered.


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