Electronic Health Records Already in OIG’s Sights for 2013!

by Ann Triebsch

The 2013 Work Plan released October 2, 2012, by the HHS Office of the Inspector General (OIG), demonstrates that even the health care industry’s brand-new electronic health records (EHR) initiative is already under scrutiny for potentially abusive and erroneous practices by some providers.  The Work Plan lists three activities that indicate that the OIG is not planning to let any bad habits (or bad actors) get established as providers get comfortable with their new EHR systems.

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Initial HIPAA Audit Report Provides Some Guidance, Identifies Top Risks

In our November 2011 blog post, we told you about the launch of HIPAA privacy and security audits mandated by Section 13411 of the Health Information Technology for Economic and Clinical Health Act (HITECH Act). KMPG, Inc. was awarded the contract to develop the audit protocol and conduct these audits last fall and, on March 1, 2012, completed its initial group of 20 audits aimed at testing the audit protocol. The United States Department of Health & Human Services’ (HHS) Office of Civil Rights (OCR) recently issued a preliminary report of the results (click here to see OCR’s slide presentation of the 2012 HIPAA Privacy and Security Audits Report). 

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Final Rule on ACOs encourages EHR adoption but eliminates “meaningful use” requirement

The Centers for Medicare and Medicaid Services (CMS) announced today, October 20, 2011, that the use of certified electronic health records (EHRs) will be the highest-weighted quality measure for an Accountable Care Organization (ACO) under the new Medicare Shared Savings Program.

ACOs are designed to encourage primary care doctors, specialists, hospitals, and other health care providers to coordinate their care. The CMS Final Rule on ACOs bases the amount of shared savings that an ACO may receive for its performance on four domains of quality: 1) quality standards on patient experience; 2) care coordination and patient safety; 3) preventive health; and 4) at-risk populations.  To earn shared savings the first performance year, providers must report across all four domains of quality, which include a total of 33 quality measures.  Providers will begin to share in savings based on how well they perform on 23 of the 33 quality measures in the second performance year and on 32 of the 33 measures in the third performance year. 

Measure 20 of the 33 quality measures requires ACOs to report the percentage of primary care providers (PCPs) who successfully qualify for an EHR Incentive Program payment.  CMS expanded the scope of PCPs who can be counted in this measure by eliminating the requirement that the PCP be a “meaningful EHR user” as defined in 42 C.F.R. § 495.4 of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.  CMS stated that it “decided to . . . expand [measure 20] to include any PCP who successfully qualifies for an EHR Incentive Program incentive rather than only including those deemed meaningful users.”

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Office of Civil Rights Steps Up HIPAA Audits

SUMMARY:  In June 2011, the  United States Department of Health & Human Services (HHS) Office of Civil Rights (OCR)contracted for new periodic audits of covered entities and business associates to ensure compliance with the Privacy and Security Standards found in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as amended by the Health Information Technology for Economic and Clinical Health Act (HITECH Act).  Announcement of these new audits followed closely on the heels of a May 2011 report from the HHS Office of Inspector General (OIG) criticizing oversight and enforcement of the HIPAA Security Rule requirements and recommending that the OCR conduct random audits. 

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HHS Releases Proposed EHR “Meaningful Use” Standards

By 2014, hospitals and physicians whom Medicare reimburses for services and items will need to have adopted an electronic health record (EHR) according to rules promulgated under the Health Information Technology for Economic and Clinical Health Act (HITECH) or risk reductions in their Medicare reimbursement. On December 30, 2009, the Office of National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid (CMS), under the auspices of the U.S. Department of Health & Human Services (HHS), released their respective proposed rules for qualifying for EHR stimulus funds under HITECH: The “meaningful use” and “certified” EHR standards. 

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