Agency questions HCFA’s ability to operate after the arrival of Y2K
Agency questions HCFA’s ability to operate after the arrival of Y2K
Doubt cast on whether bills will be paid
The General Accounting Office (GAO) is telling Congress that the Health Care Financing Administration (HCFA) has overestimated its preparedness to handle probable year 2000 computer problems.
Testifying before the House Ways and Means committee, GAO investigators said they are worried about potential delays in both Medicare and Medicaid reimbursement payments to providers and the implementation of HCFA’s year 2000 scheduled fee updates. The GAO, a congressional watchdog agency, also is concerned that Medicare may have problems processing provider claims in the first quarter of 2000.
The GAO also expressed concern about a lack of adequate contingency plans should HCFA or its contractors not be able to process provider claims or distribute payments — and what effect this could have on the quality of patient care.
To address the problem, GAO officials are urging Congress to quickly approve legislation requiring HCFA to develop payment contingency plans. Others say all payments HCFA is scheduled to make during the first quarter of 2000 should be made early so providers can continue operating should the Y2K bug disrupt HCFA’s reimbursement processes.
HHS proclaims confidence in Y2K compliance
"We are confident that all remaining mission-critical systems at HHS [Department of Health and Human Services] and Medicare contractors will be certified compliant by this summer," says Kevin L. Thurm, deputy HHS secretary in charge of the agency’s year 2000 activities. "Successful delivery and payment for HHS-supported services will depend on both our own computer systems and those of our partners, including health care providers."
In its own report to Congress, HCFA indicated that all of its 54 mission-critical systems were now Y2K-compliant, with the exception of some "minor problems." However, the GAO claims these "minor problems" are far more significant than HCFA says and none of HCFA’s mission- critical systems are truly compliant.
Meanwhile, the independent testing contractor hired by the government to verify Y2K compliance has said it will only be able to test eight of HCFA’s internal systems — a significant drop from the 22 systems HCFA had promised would be independently tested. Experts also worry that there will be little time for HCFA to execute necessary changes and contingency plans after the tests are completed in late summer.
According to the GAO, HCFA has not established an integrated schedule to track all of the agency’s major internal systems or a formal risk management system. HCFA’s independent contractor recommended earlier that HCFA develop a system to track specific information, including time, test schedules, and resource considerations.
The GAO is concerned that without this integrated schedule, HCFA’s management team will not be able to properly identify important system dependencies and prioritize the remaining work in the limited time before 2000.
Data exchange systems still need updating
A key component of HCFA’s Medicare and Medicaid computer system centers around the agency’s ability to exchange data both internally and with such external clients as physicians and hospitals.
The GAO report indicates that of HCFA’s 3,418 internal data exchange systems, 309 are not Y2K-compliant, and of 255,000 external data exchange systems, more than 37,000 are not compliant. In addition, HCFA has several internal systems scheduled for a software upgrade in 1999, several of which are legislatively mandated. All of these upgraded systems will require testing and certification — a process the GAO fears may not be completed before 2000.
Besides testing individual systems, HCFA also must institute so-called end-to-end tests of interrelated systems that collectively support a business function. While the agency plans to conduct these end-to-end tests, the GAO says HCFA has yet to create a comprehensive blueprint of when these tests will be conducted and how they will be performed.
According to a recent survey by the HHS Office of Inspector General (OIG), half of the nation’s health care providers are not Y2K-compliant. However, most say they expect to have their computer systems prepared by Dec. 31.
Providers that fail to make sure their computer systems are Y2K-compliant may face interruptions in their Medicare and Medicaid reimbursements and have problems managing electronic patient medical records, warns the OIG.
"This survey makes it clear that providers need to take steps in their own self-interest to be sure their computer systems will be able to successfully submit claims for reimbursement," says HHS Inspector General June Gibbs Brown.
The survey of 5,000 physicians, hospitals, nursing facilities, home health agencies, and durable medical equipment providers found problems with:
• Billing and financial systems. Some 50% of respondents reported that their billing and financial systems were compliant. Over 90% of hospitals reported they were not yet compliant but indicated they would be compliant by Dec. 31.
• Electronic claims. Between 50% and 63% of providers reported they are already able to enter an eight-digit date on electronic claims. However, only about a third of nursing homes indicated they would be ready to use the eight-digit field by July 1999.
• Clinical and medical record systems. About 50% of providers reported that their clinical and medical record systems were Y2K-compliant. Three-quarters said they would be ready by the end of the year. However, 47% of rural physicians and 64% of urban physicians are less likely than other provider types to have their systems ready by 2000.
• Biomedical equipment. Fewer than one-third of responding providers indicated that their bio medical equipment is currently Y2K-compliant. Overall, the survey reports that providers were far less confident in the compliance level of their biomedical equipment than in the compliance level of their computer equipment.
• Systems testing. Less than 66% of providers have replaced or renovated their computer systems for Y2K compliance. More than 50% had completed testing of their systems. However, fewer than 50% of respondents had replaced or renovated their biomedical equipment.
• Medicare contractors. Less than 60% of respondents stated that their Medicare contractor had sent them Y2K information or offered to provide assistance. In particular, only 30% of urban physicians reported that their contractor outreach programs had been informative. Only 10% to 22% of providers have actually requested Y2K-ready software from their Medicare contractor. Of those that did, between 55% to 86% reported that the software operated correctly.
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