Major upgrades fix long-standing problems with HIPAA Eligibility Transaction System

A second round of hardware and software upgrades seems to have solved long-running problems with a major IT system operated since 2005 by the Centers for Medicare and Medicaid Services (CMS), the Government Accountability Office (GAO) reported.

The HIPAA Eligibility Transaction System (HETS) used by providers and others to determine Medicare eligibility  had been plagued by slow response times and system availability problems, according to the report.

CMS implemented what the GAO described as major upgrades in 2010, but to little effect. A second round of upgrades was initiated in January 2011 to double hardware capacity, replace the operating system and upgrade software. Implementation was completed in April 2011, and a phased migration completed a month later.

The result, according to the GAO: Few user concerns among the 244 organizations using the system, including 130 providers, 10 Medicare administrative contractors and 104 information clearinghouses handling queries for 400,000 providers. Those users initiated more than 380 million transactions in the first six months of 2012 and experienced an average response time of 2 seconds.

Calls to the CMS help desk fell from an average of 133 per week before the upgrades to 64 per week shortly after implementation, according to the report. Auditors said users told them that "HETS provides faster response times as well as more complete information and reliable service than the other beneficiary eligibility verification systems they use."

HETS program officials have initiated incentive awards for contractors that perform above their contractual requirements, the GAO noted, and new processes for problem resolution. Contractors conduct daily health checks on the system, with problems referred immediately to the help desk. CMS posts notices of planned outages in advance and provides several links for HETS help and information on a central Web page.

CMS also is planning improvements to keep system performance high as usage volume increases at an anticipated rate of 40 percent annually.

To learn more:
- read the report summary
- view the full report

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