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GAO: CMS improves HETS system performance

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The Centers for Medicare and Medicaid Services significantly improved customers' experience with the HIPAA Eligibility Transaction System after replacing and upgrading hardware and software, and enhancing information technology support, according to the Government Accountability Office.

The query and response system, commonly known as HETS (the "HIPAA" in the acronym stands for Health Insurance Portability and Accountability Act), provides users with real-time data on Medicare beneficiaries and their eligibility to receive payment for health care services and supplies, says a GAO report (.pdf) dated Sept. 12 but not released publicly until Oct. 5. Oerational problems plagued the system in 2010 and part of 2011, say report authors.

In interviews with auditors, HETS users said they are no longer experiencing operational or communication issues. Report authors found the number of help desk calls by users declined from an average of 133 calls per week during the first quarter of 2011 to an average of 64 per week during the second quarter of 2012.

Users also said HETS provides faster response time and more complete results than electronic eligibility tools provided by commercial health insurers, says the report.

Support for the system is also more robust, say report authors. The agency notifies users of performance or availability issues and posts messages to the system website if there is a problem it is working to resolve. Sometimes outages were necessary in addition to regularly-scheduled downtime, in which case the CMS help desk notified users in advance of any unscheduled system outages, says the report.

The agency is doing more to ensure help desk contractors meet quality and service requirements by reviewing their performance every 6 months.

Auditors welcome the improvements CMS has made, as system usage is only increasing. In the first 6 months of 2012, the system processed more than 380 million transactions--averaging anywhere from 1.7 million to 2.2 million queries per day, says the report. And CMS officials told auditors they project transaction volume to increase at about 40 percent per year.

In preparation for increased volume, CMS officials described to auditors plans to redesign the system and upgrade more hardware.

For more:
- download the report, GAO-12-973 (.pdf)

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