CMS System Not Properly Sharing Information on Terminated Providers
A Web-based portal for sharing information about terminated providers that was established by the Centers for Medicare and Medicaid Services under the Affordable Care Act is not working as intended, according to a new report from the Department of Health and Human Services’ Office of Inspector General.
A Web-based portal for sharing information about terminated providers that was established by the Centers for Medicare and Medicaid Services under the Affordable Care Act is not working as intended, according to a new report from the Department of Health and Human Services' Office of Inspector General.
OIG examined all provider records contained in the Medicaid and Children's Health Insurance Program State Information Sharing System (MCSIS) as of June 1, 2013, and found that while the system contained records on terminated providers submitted by CMS and 33 State Medicaid agencies, it did not contain records from the remaining State Medicaid agencies.
In addition, contrary to CMS guidance, about one-third of the 6,439 records in MCSIS did not relate to providers terminated "for cause" and more than half of the records did not contain National Provider Identifiers, which OIG says is "a critical data element for accurately identifying providers." Moreover, one-third of MCSIS records did not identify the provider types and one quarter had no provider addresses. Properly sharing terminated provider data among states prevents terminated providers in one state from enrolling in another state, according to OIG.
"Our findings suggest that CMS's process for sharing information on terminated providers needs improvement to make it more useful to State Medicaid agencies in identifying providers that must be terminated pursuant to Federal law because they were terminated 'for cause' by Medicare, Medicaid, or [Children's Health Insurance Program]," states the report.
OIG recommended that CMS require each State Medicaid agency to report all terminated providers, ensure that the shared information contains only records that meet CMS's criteria for inclusion, and take action to improve the completeness of records shared through the process. CMS concurred with all of OIG's recommendations.
In its report, OIG noted that in November 2013 CMS revised its process for sharing information about terminated providers. "The findings and recommendations in this report remain relevant to the new process," said OIG.
OIG examined all provider records contained in the Medicaid and Children's Health Insurance Program State Information Sharing System (MCSIS) as of June 1, 2013, and found that while the system contained records on terminated providers submitted by CMS and 33 State Medicaid agencies, it did not contain records from the remaining State Medicaid agencies.
In addition, contrary to CMS guidance, about one-third of the 6,439 records in MCSIS did not relate to providers terminated "for cause" and more than half of the records did not contain National Provider Identifiers, which OIG says is "a critical data element for accurately identifying providers." Moreover, one-third of MCSIS records did not identify the provider types and one quarter had no provider addresses. Properly sharing terminated provider data among states prevents terminated providers in one state from enrolling in another state, according to OIG.
"Our findings suggest that CMS's process for sharing information on terminated providers needs improvement to make it more useful to State Medicaid agencies in identifying providers that must be terminated pursuant to Federal law because they were terminated 'for cause' by Medicare, Medicaid, or [Children's Health Insurance Program]," states the report.
OIG recommended that CMS require each State Medicaid agency to report all terminated providers, ensure that the shared information contains only records that meet CMS's criteria for inclusion, and take action to improve the completeness of records shared through the process. CMS concurred with all of OIG's recommendations.
In its report, OIG noted that in November 2013 CMS revised its process for sharing information about terminated providers. "The findings and recommendations in this report remain relevant to the new process," said OIG.