GAO is a congressional investigative unit that often takes federal government agencies to task for flaws in their processes, including information technology initiatives, and for lengthy delays in fixing the flaws.
When GAO examined Medicare’s eligibility transaction system, called HETS, it found that operational problems users experienced in 2010 and the first few months of 2011 had been resolved by Spring 2011 following several hardware and software upgrades and replacements. “System performance reports for the first six months of 2012 showed that the average response time per transaction was less than three seconds,” according to a report published Oct. 5 and available here. “Users described experiences with the system that were consistent with these data. They told us they are currently satisfied with the operational status of HETS and that the system provides more complete information and reliable service than other systems that they use to verify eligibility with commercial health insurers.”
The Centers for Medicare and Medicaid Services took further steps to ensure customer satisfaction by notifying users in advance of system downtime for maintenance, providing help desk support and monitoring contractors’ performance, according to the report. Further, the HHS Office for Civil Rights confirmed to GAO that no privacy violations have been reported since HETS became operational.
Another surprise in the report is how few providers actually use HETS, which first rolled out in 2005, although CMS anticipates 40 percent annual growth in transactions. Most recently, 244 entities were using HETS including 130 provider organizations, 104 clearinghouses and 10 Medicare contractors, with about 1.7 million to 2.2 million queries processed daily.