Anti-Fraud Model Requirements for Electronic Health Record Systems (EHRs)

Please find below information released from RTI earlier today concerning the upcoming public comment period for a set of Anti-Fraud model requirements for EHR systems. 

We are inviting you/your organization to be involved in the public comment period, due to your interest and expertise in these requirements.  An additional document outlining the process of creating these requirements is attached.  If you have any further questions, please contact antifraud@....

Thanks, and Happy Holidays!

Researchers Seek Comments on Recommendations Designed to Improve Efficiency, Prevent Health Care Fraud

RESEARCH TRIANGLE PARK, N.C. (Dec. 21, 2006) – Researchers at RTI International are seeking comments from industry leaders, practitioners and the general public on  model standards to prevent medical claims errors and detect health care fraud that will be recommended for use in electronic health record systems (EHRs).

             These model claims efficiency standards currently being developed by a team of experts assembled by RTI will aim to improve claims accuracy and to reduce the ability for individuals to create fraudulent claims and other improper payments against public and private health care plans.

             Those interested in reviewing and commenting on the recommendations must register at http://ehrantifrauddev.rti.org. Registrants will receive information on how to review the standards once they are released near the end of December. The review process will be completed at the end of January.

             “The move to EHR systems represents a unique opportunity for improving billing  accuracy and reducing health care fraud and improper payments, however the model standards developed must be critiqued by the larger community in order to be meaningful and useful to those who will use the systems,” said Colleen McCue, Ph.D., a senior research scientist at RTI and project manager. “Everyone who would like to comment has the opportunity.”

             The executive team charged with delivering the final model requirements will revise the draft anti-fraud requirements based on the public feedback they re­ceive.

             The six-month project was awarded to RTI by the Office of the National Co­ordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services (HHS). As part of the contract RTI researchers are work­ing with The Foundation of Research and Education, an affiliate of the American Health Information Management Association (AHIMA) and SPSS to take a proactive approach to preventing health care fraud.

             “Currently, most billing errors or fraud is detected after payment is made, which makes dealing with the claims very inefficient for both the provider and the payer,” McCue said. “EHR systems will allow for the opportunity to correctly bill from the very beginning, which will help physicians to receive accurate payments and ultimately, will reduce fraud.”

             The research team is working with National Health Care Antifraud Associa­tion (NHCAA), health care providers, health insurers, federal agencies, and the Health Information Technology Standards Panel (HITSP) to develop model claims effi­ciency standards for EHRs that will prevent, detect and support the prosecution of health care fraud as well as minimize opportunities for error or fraud