Medicaid's upgraded claims management system struggles to integrate reliable data

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After missing several implementation deadlines, Medicaid's claims management system is struggling with how to organize its data.

After postponing implementation deadlines six times, Medicaid’s revamped data system is facing further delays along with concerns about the reliability of data coming in from states.

Initially scheduled for a full implementation by July 2014, the Transformed Medicaid Statistical Information System (T-MSIS) has been plagued by technical challenges that repeatedly delayed the implementation deadline. As of December 2016, less than half of state Medicaid programs were reporting to the system, according to a report released by the HHS Office of Inspector General on Tuesday.

However, state participation has nearly doubled in the last six months, according to the Centers for Medicare and Medicaid Services. In a letter to OIG, CMS Administrator Seema Verma said more than 41 entities representing 92% of Medicaid’s population are submitting data as of June 6.

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The agency has established a goal to have all 53 Medicaid entities reporting to the system by the end of the year. But given CMS’s tenuous history, OIG said it is concerned CMS will “continue to delay rather than assign the resources needed to address the outstanding challenges by the deadline.”

OIG’s other primary concern revolves around data reliability—an issue that both state agencies and CMS have acknowledged. According to OIG’s analysis, only 26% of all data elements were submitted by states, and different jurisdictions have inconsistent interpretations of the same data element.

A national database has “enormous potential” to better manage the program and prevent fraud, waste and abuse, according to the watchdog agency, but inconsistent data would render the subsequent analysis unreliable. The federal government has set aside funding for Medicaid IT upgrades over the last several years and invested heavily in data analytics to root out fraud within the Medicare program.

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Following a 2013 report that highlighted data consistency issues, CMS established standards for accuracy, created an oversight strategy and validation rules. But none of those interventions seem to have resolved the system’s problems.

“OIG considered the recommendation to be implemented,” the report stated. “Yet disappointingly, despite these efforts, there are still concerns about the completeness and reliability of the data.”

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