Medicare Compliance & Reimbursement

HHS wants physician-tracking systems up to snuff.

Insurance carriers' progressive corrective action tracking systems can't show whether the corrective action strategies are working, the HHS Office of the Inspector General maintains.

In an Oct. 21 audit report, the OIG urges Medicare carriers to track the results of quarterly physician reassessments and perform better analyses on whether their progressive corrective action strategies are effective. The Centers for Medicare and Medicaid Services "relies primarily on compliance-based oversight mechanisms that do not address progressive corrective action outcomes," the OIG says.

As a result, the watchdog agency had no success in determining whether the corrective action strategies actually reduce physician error rates or modify physician behavior.
 
CMS should institute outcome-based program measures to better assess corrective action strategies' impact, the OIG recommends. The OIG also wants a CMS review of carrier tracking systems' compliance  with requirements.