OIG report suggests ‘best practices’ to help prevent EHR fraud

It was a nice holiday for my brain here is the latest and greatest!!

A federal watchdog says the CMS and its Medicare contractors could do more to ensure providers don’t use electronic health-record systems as a means to fraudulent ends.

The 17-page report by HHS’ Office of the Inspector General is the latest salvo in a running debate between federal regulators on the one side and providers and technologists on the other over the appropriate use of healthcare information technology.

The watchdog recommended that the CMS work with its contractors to develop and disseminate a set of “best practices” to guide contractors in detecting EHR-linked fraud, and that the CMS should direct contractors to use EHR audit logs when reviewing medical records as part of routine compliance operations. 

Audit logs that are “always operational” and can “never be altered” provide “the most benefit” in fraud detection, the OIG said.

This fight stretches back at least to September 2012, when HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder fired off a letter to the heads of a handful of healthcare organizations warning them about “troubling indications” that EHRs were being used to commit billing and payment fraud.

 

The implied threat sparked protests from leaders of provider groups

Dr. Scot Silverstein, a physician informaticist and frequent critic of the federal approach to promote EHR adoption, which he recently described as “the push towards EHR unicorns and moonbeams utopia,” said the OIG report, while disclosing nothing new, indicates “the federal government is incompetently tripping over its own feet.” 

The OIG issued a report last month that identifies design weaknesses that render EHR systems vulnerable to abuse

In its latest report, the OIG concluded that the CMS and its contractors used “few program integrity practices specific to EHRs.” For example, just three of 18 contractors, in response to an OIG questionnaire, reported using audit-log data from an EHR as part of their fraud fighting reviews and only four of 18 indicated they reviewed EHR records differently than paper records, the OIG report said.

“Not all contractors reported being able to determine whether a provider had copied language or overdocumented” an encounter in an electronic medical record, the OIG report authors said. Meanwhile, CMS guidance provided to its contractors on fraud vulnerabilities was described as “limited.”

The report cites two examples of electronic record documentation practices—copying and pasting and overdocumentation—that could be used to commit fraud. These electronic vulnerabilities require that the CMS and its contractors develop new techniques for finding and investigating improper payments. 

Also known as cloning of a medical record, copying and pasting enables a user to take portions of an existing record and add it to another record. When clinicians cut and paste information without updating or ensuring its accuracy, “inaccurate information may enter the patient’s medical record and inappropriate changes may be billed to patients” and third–party payers, the OIG said. The practice also could be used to create fraudulent claims, the authors said. 

The OIG describes overdocumentation as inserting false or irrelevant documentation to fabricate support to bill for more expensive services, a practice the investigators said can be facilitated by EHRs that “auto-populate” data fields in the record when using templates built into these systems. 

Other systems, the OIG said, “generate extensive documentation on the basis of a single click of a checkbox,” which also could introduce errors in the patient record as well as facilitate fraudulent claims by making it appear as if the patient received more comprehensive services than the provider actually rendered. 

The report was based on a review of CMS documents providing guidance to healthcare delivery organizations on fraud as well as interviews with and a questionnaire sent to CMS administrative officials and hired contractors.

 
Thanks for this Joseph Conn!! Follow him on twitter at @MHJConn
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IRS guidance is changing regarding tax form 1099s issued for the Medicaid EHR Incentive Program.

The Final IRS guidance will be released, likely by the end of the year.  This notice is the heads up that the guidance is changing. Click here for more information and as more information becomes available I will pass it on.

 

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Hospital Facebook Post Leads to ID Theft

An Arizona hospital is facing scrutiny after one of its employees posted a workplace photo on Facebook, inadvertently including the protected health information and Social Security number of a patient.

The University of Arizona Medical Center South-Campus confirmed that an emergency room employee posted a photo of her workstation back in June, which included a shot of a computer screen containing the patient’s information, according to a report from Green Valley News. Four months later in October, the patient notified law enforcement that she was the victim of identity theft, as someone had attempted to use her information to qualify for food stamps.

 

Although the photo was removed from Facebook reportedly 30 minutes after it was posted, the patient expressed concern that the employee and their friends are still in possession of the photo. “I want everybody to know about this,” the patient said to GVN. “I don’t want anyone else to go through this kind of hell.”

 

This is far from the first incident where hospital employees have posted patient data on social media sites — either advertently or inadvertently.

 

Back in 2010, Alexandra Thran, MD, was fired from Rhode Island-based Westerly Hospital after she posted a trauma patient’s data to a social media site. Although the patient’s name wasn’t listed, enough information was available so the patient could be identified in the community.

 

In 2011, a staffing agency employee working at Providence Holy Cross Medical Center in Mission Hills, Calif., reportedly posted a patient data on his Facebook page, ridiculing the patient’s medical condition, the Los Angeles Daily Newsreports. “Funny but this patient came in to cure her VD and get birth control,” he wrote along with a photo of the patient’s medical record.

 

Incidences such as these, cropping up nationwide, have prompted many organizations to adopt strict social media policies for employees.

 
For more information, click here.

 

Thanks to UCFREC for the information!

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RECs : Advising Providers in All Phases of Electronic Health Record Implementation

The ONC’s Regional Extension Centers (RECs), located in every region of the country, serve as a support and resource center to assist providers in EHR implementation and HealthIT needs. As trusted advisors, RECs “bridge the technology gap” by helping providers navigate the EHR adoption process from vendor selection and workflow analysis to implementation and meaningful use.

Find Your Regional Extension Center

RECs at a Glance

  • As of July 2013,
    • Over 147,000 providers are currently enrolled with a Regional Extension Center. Of these, more than 124,000 are now live on an EHR and more than 70,000 have demonstrated Meaningful Use
    • 41% of PCPs nationwide are enrolled with an REC; 51% of rural PCPs are enrolled
    • 85% of REC-enrolled providers are live on an EHR vs. 62% live on an EHR in the general provider population
    • 872 CAHs/SRHs have been paid for MU (1,073 have attested)
  • RECs are part of eight working groups on emerging business lines in support of practice transformation including: privacy and security, accountable care organizations, patient centered medical home, health information exchange, and patient engagement.

West Texas Health Information Technology Regional Extension Center (WT-HITREC)

The West Texas Health IT Regional Extension Center (WTxHITREC), a program of the F. Marie Hall Institute for Rural and Community Health at Texas Tech University Health Sciences Center, focuses on the health information technology needs of health care providers and hospitals in West Texas.  The WTxHITREC serves as the federally designated Regional Extension Center for the 108 most-western counties of Texas.

Services

  • Meaningful Use Support
  • Functional Interoperability and Health Information Exchange Support
  • Privacy and Security Best Practices Education and Resources
  • Accountable Care Organization Education and Support
  • Patient-Centered Medical Home Education and Support
  • ICD-10 Transformation
  • Joint Commission Education and Support
  • Workforce Development
  • Par for Performance Education and Support
  • Quality Coaching Education and Support
  • Bridges to Excellence Education and Support
  • Additional Incentive Education and Acquisition
  • National Committee for Quality Assurance (NCQA) Education and Support

Achievements

  • Assisted over 933 physicians in West Texas, with a 64% success rate of Meaningful Use attestation ( as of November 11, 2013)
  • Serviced over 1200 Total Providers since the programs inception.
  • Assisted over 56 critical access and rural hospitals in West Texas, with a 57% success rate of Meaningful Use attestation.
  • Helped bring over $11 million incentive dollars to health care providers in West Texas
  • Helping more than 69% of FQHCs in West Texas
  • Recently contracted with THSA to assist providers in West Texas in connecting to a HISP and sending DIRECT protocol secure email messages.
  • Currently under contract with HHSC to help connect providers and re-align the West Texas White Space by creating a Board of Advisors tasked with selecting the appropriate solution for the region.

Connect with WT-HITREC: Website | Facebook | Twitter

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Stage 2 Meaningful Use Guidelines: Texas Medicaid EHR Incentive Program

On September 4, 2012, CMS published a final rule that specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) must meet in order to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

Below are the key points of interest regarding Stage 2.

I. Program Guidance: Stage 2 Start Dates

  • Eligible Hospitals (EHs): Fiscal Year 2014 (October 1, 2013)
  • Eligible Professionals (EPs): Calendar Year 2014 (January 1, 2014)

II. Program Guidance: Stage 1 and 2 Meaningful Use Stages, Timing, and Payments

The table below illustrates the progression of meaningful use stages from when a Medicaid provider begins participation in the program.

  • Year 1 : $21,250
  • Year 2 : $8500
  • Year 3 : $8500
  • Year 4 : $8500
  • Year 5 : $8500
  • Year 6 : $8500

Eligible providers may not start participation in the incentive program after 2016.

Skipping Years
Providers in the Medicaid EHR Incentive Program may skip participation years if they choose. The program ends in 2021, so if an EP starts in 2016 (the last year you can begin the program), that EP would need to participate in consecutive years if they want all six payments.

  • Skipping years is still allowed, but the EP would not receive all six payments.

Exclusions No Longer Count Toward Menu Objectives, With One Exception

Beginning in 2014, providers will no longer be permitted to count an exclusion toward the minimum number of five (Stage 1) or three (Stage 2) menu objectives on which they must report if there are other menu objectives which they can select. In other words, a provider cannot select a menu objective and claim an exclusion for it if there are other menu objectives they can meet.
They will not be penalized for claiming an exclusion if they would also qualify for the exclusions for all the remaining menu objectives.

III. Reporting Period for Meaningful Use

For 2014 ONLY: 90‐day Reporting Period for All Providers

All providers, regardless of their stage of meaningful use, are only required to demonstrate meaningful use for a 90‐day EHR reporting period. For the Medicaid EHR Incentive Program, this continuous 90‐day period can be selected from any point in the reporting year.

Beyond 2014: Reporting Period for Demonstrating Meaningful Use 

In the first year of reporting meaningful use, providers must demonstrate MU for a 90‐day reporting period. In subsequent years, providers will report meaningful use for a full year (an entire fiscal year for hospitals or an entire calendar year for EPs) except in 2014, which is described above.

IV. Meaningful Use (MU) Measures
Number of Core and Menu Measures for EPs and EHs
The total number of MU objectives remains the same in Stage 2. However, the number of required, or core, measures has increased, while the number of optional, or menu, measures has decreased:

 Eligible Professionals (EPs): 20 total
o 17 core objectives (from the original 15 in Stage 1)
o 3 of 6 menu objectives (5 of 10 in Stage 1)

 Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs): 19 total
o 16 core objectives (from 14 in Stage 1)
o 3 of 6 menu objectives (5 of 10 in Stage 1)

Stage 2 MU Changes

  • Some Stage 1 objectives were either combined or eliminated for Stage 2.
  • Most of the Stage 1 menu objectives are now core objectives in Stage 2.
  • For many of the Stage 2 objectives, the threshold that providers must meet has been raised.

Eligible Professionals: MU Measures

Eligible Hospitals: MU Measures

V. Clinical Quality Measures (CQMs) for 2014 and Beyond

Beginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers.
1. EHR technology must be certified to the 2014 criteria. EHR technology that has been certified to the 2014 Edition standards and certification criteria will have been tested for enhanced CQM‐related capabilities. Eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will be required to report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

2. CQMs still required to demonstrate MU. Although CQM reporting has been removed as a core objective for both EPs and eligible hospitals/CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use.

Key Points about Clinical Quality Measures in 2014 and Beyond:
 CQM requirements are associated with the current year and must be an output of the current certified EHR technology.
 Starting in 2014, all providers must select CQMs from at least three of the six Health and Human Services (HHS) National Quality Strategy Domains:

  • Patient and Family Engagement
  • Patient Safety
  • Care Coordination
  • Population and Public Health
  • Efficient Use of Healthcare Resources
  • Clinical Processes / Effectiveness

EPs must report on 9 out of 64 total CQMs.
EHs must report on 16 out of 29 total CQMs.
 EPs are encouraged, but not required, to report from the recommended set of either adult core measures or pediatric core measures.

 

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White Space HIE Re-alignment Initiative

The WTxHITREC has been selected by HHSC (Health and Human Services Commission) to support a planning process that convenes interested stakeholders and healthcare leaders in the “White Space” to identify an HIE (Health Information Exchange) model for the White Space region.  The White Space is a collection of counties that do not have a State supported query-based HIE.  In that regard, the WTxHITREC is holding meetings in Wichita Falls, Abilene, and San Angelo to 1) understand the HIE needs and preferences in the White Space and 2) identify participants for a West Texas HIE Advisory Committee that will ultimately identify the HIE solution for the White Space Region.  Additionally, for those that are unable to attend one of these meetings,  the WTxHITREC has scheduled 2 webinars.  Having said/typed all of that, this is an opportunity for you to help determine the future of HIE in West Texas.  We would welcome your expertise and opinions on this topic.  Please understand that you do not have to have a strong IT background.  Quite the opposite.  We are looking for leaders that understands finance, business process, and a “feel” for project development and management.

HIE Stakeholder Meetings—Attend for free!
 San Angelo, TX—November 14th, 3pm-6pm—Marriott Springhill Suites
 Wichita Falls, TX—November 19th, 3pm-6pm—Wellington Banquet & Conference Center
 Abilene, TX—November 20th, 3pm-6pm— Hilton Garden Inn
 Webinar—November 21st, 12-1pm
 Webinar—November 22nd, 12-1pm

Drinks, snacks, and hors d’oeuvres will be provided at each location. Space is limited, so please RSVP by November 7th for one of these offerings.

Please visit https://www.surveymonkey.com/s/HIEregistrationform to register

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Stage 1 Meaningful Use Calculator Includes Updated Measure Requirements

The Stage 1 Meaningful Use Attestation Calculator can help you prepare to enter your meaningful use information into the CMS attestation system. Enter your meaningful use data into the calculator to learn if you have met all of the objectives and the associated measures prior to completing attestation for Stage 1 of the EHR Incentive Programs.
Calculator Updates 
The updated calculator reflects the latest requirements for participation in Stage 1 of meaningful use.
Changes include:    
  • Removal of core measures no longer required for Stage 1
  • Updates to measure requirements in accordance with the Stage 2 rule
You can find the Stage 1 Meaningful Use Attestation Calculator and more information about the attestation process on the Registration & Attestation page of the EHR Incentive Programs website.
In order to better understand the meaningful use criteria, you can also review the Stage 1 Meaningful Use Specification Sheets for eligible professionals or for eligible hospitals and CAHs. These specification sheets contain detailed information on each core and menu meaningful use measure.
Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
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