More on Claims Processing

Top management and performance challenges facing HHS released

The U.S. Department of Health and Human Services (HHS) will need to place a lot of emphasis on implementing the Affordable Care Act (ACA) in the coming year, according to the Office of Inspector General’s (OIG) annual summary of management and performance challenges facing the agency, released this week.

Annually, the OIG identifies the most significant management and performance challenges facing HHS. The challenges reflect continuing vulnerabilities that OIG has identified for HHS over recent years, as well as new and emerging issues that HHS will face in the coming year, according Donald White, spokesperson for the OIG.

[See also: OIG releases HHS' top management and performance challenges]

The assessment is included as an appendix to the publicly available HHS annual Agency Financial Report.

For 2012, OIG’s top management challenges include:

  • Implementing the Affordable Care Act. “Although much has been accomplished, significant provisions remain to be implemented, most notably the Affordable Insurance Exchanges,” reads OIG’s report, “which add a new dimension to the program landscape.” In addition to implementing the exchanges, HHS must also focus on new and modified program responsibilities relating to private insurance, Medicare, Medicaid, the Children's Health Insurance Program, public health service programs, among others. “The OIG will be continuing to monitor the progress of the ACA as it is implemented,” said White.
  • Identifying and reducing improper payments. HHS needs to continue to monitor its payment systems and prepayment reviews and to develop error rates for additional programs as well as expand its education efforts. “The Department should continue to identify best practices in the private sector that it can use to further prevent improper payments,” according to the report.
  • Preventing and detecting Medicare and Medicaid fraud. The Centers for Medicare & Medicaid Services (CMS) has opportunities to strengthen the enrollment system, including adopting a more flexible screening approach and tailoring screening measures to fraud risks. CMS should also focus enrollment scrutiny on providers such as independent diagnostic testing facilities and comprehensive outpatient rehabilitation facilities. HHS should continue to focus on accountability for fraud as well.
  • Ensuring patient safety and quality of care. HHS should continue to prioritize quality of care and patient safety and build upon its past efforts, including continuing to implement the quality improvement provisions of the ACA and achieving the goals set by the Partnership for Patients and the National Quality Strategy.
  • Avoiding waste and promoting value in healthcare. HHS should continue to seek opportunities to harness the promise of value-driven payment. HHS should also continuously evaluate the effectiveness of payment policies and scrutinize payment systems to ensure that quality, efficiency and payment accuracy goals are met.
  • Grants management and administration of contract funds. HHS must vigilantly monitor and manage new and continuing grant programs. With respect to contract funding, HHS has advised that it is heavily focused on preventing new violations and that it is taking legally appropriate actions to ensure that there are no further violations of the Antideficiency Act among ongoing contracts.
  • Protecting consumers of food, drug and medical devices. HHS and the U.S. Food and Drug Administration (FDA) will need to focus on implementing the new Food and Drug Administration Safety and Innovation Act, which was signed into law in July 2012. In addition, FDA will need to continue its efforts to fully implement the Food Safety Modernization Act signed into law in January 2011 to better protect the nation's food supply.
  • Integrity and security of health information systems and data. HHS needs to heighten its focus on oversight and enforcement of privacy and security protections to ensure that healthcare providers and the department's own systems and contractors effectively safeguard individuals' protected health and other sensitive personal information. This should entail continued compliance reviews to ensure adoption of adequate privacy and security standards. “We have a special interest in health technology. We believe it holds great promise,” said White.
  • Fostering an ethical and transparent environment. To encourage an environment of transparency and accountability among contractors, HHS should do more to identify and address conflicts of interest among internal and external stakeholders.

 

[See also: OIG report says nursing homes overbilled Medicare by $1.5B]

Show All Comments

Advertisement. Closing in 15 seconds.