Data limitations mean that most states with an incentive program in place for Medicaid providers to adopt electronic health records plan to only partially verify eligibility, says the Health and Human Services inspector general.

In a report dated July 15, auditors say that federal incentives for EHR adoption among Medicaid providers will likely total $13.4 billion between fiscal 2011 and 2019 (and another $7.2 billion for Medicare providers).

As of January, 14 states have set up Medicaid EHR incentive programs, through which federal aid is channeled. Auditors examined 13 of them, and concluded that of the 11 Medicaid EHR program eligibility requirements, only Kentucky will verify all of them, and only by resorting to resource-intensive means.

Other unnamed states join Kentucky in planning resource-intensive and "logically impractical" verification methods, the report states--for example, verifying the adoption, implementation or upgrading of an EHR by examining documentation such as receipts or vendor contracts.

The 13 states scrutinized by auditors plan on average to examine approximately eight of the 11 verification requirements, with Wisconsin at the extreme low end at just six requirements.

Most states said they will use data from the Medicaid Management Information Systems to verify Medicaid patient volume--but some states that have done so found that payments don't always track with patient volume. For example, obstetricians/gynecologists receive a flat Medicaid fee for all patient visits associated with prenatal care, meaning that each distinct visit goes unrecorded as a percentage of total volume.

Partial verification might be an ongoing state of affairs, since much of the data needed for verification wasn't previously required and increasing data collection would be expensive, state officials told auditors.

As a result, states should take those limitations into account when conducting oversight. "For example, States could strengthen oversight of their EHR incentive programs by focusing post payment audits on eligibility requirements that cannot be completely verified prior to payment," the report says.

States that have not yet set up EHR Medicaid incentive programs would also take into account MMIS limitations, the report adds.

For more:
- download the report, OEI-05-10-00080 (.pdf)

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