President Obama has released a detailed summary of a new health care reform plan that includes several proposals that would use information technology to reach specific goals. Many of the I.T. proposals target waste, fraud and abuse in the industry.
The President's proposal, however, does not appear to include a provision that was in the House and Senate reform bills that called for adoption of "operating rules" that would augment the HIPAA transaction standards.
These rules come from the Committee for Operating Rules initiative of CAQH, a Washington-based health payer advocacy group. Stakeholders across the industry have spent several years developing rules that would, in essence, standardize the HIPAA standards.
Proposals in Obama's new proposal with a strong I.T. flavor include:
• Establish a Medicare/Medicaid sanctions database overseen by the Health and Human Services' Office of the Inspector General. The database would enable law enforcement agencies to access past sanctions on providers, suppliers and related entities.
• Expand assess to the Healthcare Integrity and Protection Data Bank to quality control and peer review organizations, and private health plans furnishing items and services reimbursed by federal health plans.
• Hold Medicare contractors liable for payment of claims submitted by individuals or entities excluded from the program.
• Adopt real-time analysis of claims and payments data to identify waste, fraud and abuse in public health programs.
• Establish a CMS/IRS data-matching program to match information on entities that have evaded filing taxes against provider billing data to better detect fraudulent providers.
• Require HHS to study and report to Congress the costs and benefits of assigning universal product numbers to select items and services reimbursed under Medicare.
The President's new health reform proposal, which he presented on Feb. 22 to the National Governor's Association meeting in Washington, is available at whitehouse.gov/health-care-meeting/proposal.
This story has been reprinted with permission from Health Data Management.
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