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CMS must beef up its IT and guidance for clinicians to make MACRA work, OIG says

Clinicians need technical assistance and greater program integrity to keep QPP from risk of fraud and improper payments.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Services has fallen short in two areas of preparing for the quality payment program for MACRA, according to a recent review by the Office of the Inspector General for the Department of Health and Human Services.

Clinicians need technical assistance and greater program integrity to keep the program from risk of fraud and improper payments, according to the OIG report.

[Also: CMS adds new measures to compare hospitals on care quality]

That means CMS has to provide sufficient guidance to ensure that clinicians are ready to take part in the quality payment program, and the agency needs to develop IT systems to support data reporting, scoring and payment adjustment, the report said.

The first performance year of MACRA is 2017, for payment in 2019.

[Also: CMS finalizes rule canceling mandatory bundled payment models]

CMS set up two tracks of quality payments, MIPS and advanced alternative payment models.

Last year, the OIG conducted an initial review of CMS's management of the payment program and said it found significant progress has been made.

CMS appears on track to deploy IT systems needed for data submission by Jan. 1, 2018, the OIG said.

With regard to clinician readiness, CMS has conducted outreach, awarded technical assistance contracts, communicated eligibility information, issued subregulatory guidance and established a service center to respond to questions.

But the follow-up review shows CMS needs to address vulnerabilities regarding IT systems and preparedness.

"However, clinician feedback collected by CMS demonstrates widespread awareness of the QPP, but also uncertainty about eligibility, data submission and other key elements of the program," the OIG said. "With regard to emerging challenges, we found that CMS has not yet developed a comprehensive program integrity plan for the QPP."

Twitter: @SusanJMorse
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