Benefits Administration

GAO confirms Medicare system vastly improved

The Centers for Medicare and Medicaid Services has made successful strides in the last two years in its automated query and response system, according to a new report.

CMS’ Health Insurance Portability and Accountability Act of 1996 Eligibility Transaction System (HETS) is a real-time data processing environment that operates 24 hours a day, 7 days a week. It provides data to users about Medicare beneficiaries and their eligibility to receive payment for health care services and supplies. From January through June, HETS processed each month an average of 1.7 million to 2.2 million queries per day, GAO reported in its report released Oct. 5.

CMS officials turned around the foundering system this year. They made several hardware and software replacements and upgrades, and system performance reports for the first six months of this year showed the average response time per transaction was less than 3 seconds. Since then, users find the system running well.

“They told us that they are currently satisfied with the operational status of HETS and that the system provides more complete information and reliable service than other systems that they use to verify eligibility with commercial health insurers,” GAO wrote.

In efforts to improve HETS, CMS began notifying users in advance of system downtime for repairs, which often happen early on Monday mornings. Officials also provide help desk support and they monitor contractors’ job performance.

On top of that, CMS is preparing for increased usage. The agency has planned several technical improvements to boost HETS’ processing capacity. Officials project a growth rate of about 40 percent annually. Officials plan for a redesign of the system and migration to a new database environment.

In the immediate, HETS program officials told GAO they plan to soon set up tools to enable proactive monitoring of the system’s components and additional services intended to enhance production capacity until the system redesign is finished.

In response to the report, Health and Human Services Department told GAO it will continue its improvements to keep HETS’ running smoothly.

After apologizing for the problems in 2010 and 2011, Jim Esquea (pictured), assistant secretary for legislation at HHS, wrote, “HHS is pleased that GAO confirmed CMS’s success at correcting operational problems and improving the reliability of the HETS.”

About the Author

Matthew Weigelt is a freelance journalist who writes about acquisition and procurement.


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