Responding to a EHR Meaningful Use Audit

EHR Meaningful Use Audits are Ongoing. Call Liles Parker for Assistance in Responding.

(April 3, 2015): Starting this year, eligible providers who have not attested to meaningful use of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for 2014 will face a 1% penalty on Medicare reimbursement. The penalties will increase to 2% in 2016 and 3% in 2017. Depending on the total number of Medicare eligible professionals who are meaningful users under the EHR Incentive Programs after 2018, the maximum payment adjustment can reach as high as 5%. Eligible providers and hospitals should make sure they have sufficient documentation so that they are prepared to respond to a possible EHR meaningful use audit. Key focus areas of an EHR meaningful use audit will likely include eligibility and meaningful use criteria, Health Insurance Portability and Accountability Act (HIPAA) security risk analysis and mitigation documentation, and documentation of the program.

I. Overview of the EHR Meaningful Use Audit Process:

The meaningful use audit process typically begins with your receipt of an initial request letter seeking information and documentation regarding your efforts to comply with applicable meaningful use requirements. This letter will likely either come directly from CMS or the audit firm CMS has engaged has engaged to conduct meaningful use audits. An eligible provider will have two weeks to respond to the letter and provide the documentation that has been requested. Following submission, the initial review process will commence, where CMS and/or its audit vendor will examine the documentation. Depending on CMS’s findings and concerns, an onsite review may be needed. Finally, the eligible provider will receive an audit determination letter. The letter will inform the provider whether they were successful in meeting meaningful use of electronic health records. If a provider is found not to be eligible for an EHR incentive payment, the payment will be recouped.

II. Preparing for an EHR Meaningful Use Audit:

To avoid penalties for 2016, eligible health care providers and hospitals should start gathering meaningful use supporting documentation now, not after an audit has been initiated. Specifically, they should retain all relevant supporting documentation used to complete the Attestation Module responses. Providers should keep summary data from the certified EHR system, but because some certified EHR systems are unable to generate reports that limit the calculation of measures to a prior time period, providers should also download and/or print a copy of the report used at the time of attestation for their records. They should also download and/or print primary evidence of eligibility. Primary evidence documents will be needed for more detailed reviews, and should include, at minimum, the numerators and denominators for the measures, the time period the report covers, and evidence to support that the documentation was generated for that eligible provider or hospital.

In addition, not all certified EHR systems currently track compliance for non-percentage-based meaningful use objectives. These objectives typically require a “Yes” attestation in order for a provider to be successful in meeting meaningful use. To validate provider attestation for these objectives, CMS and its contractor may request additional supporting documentation. Any non-EHR based reports should demonstrate the time period of the reports, proof that the report was not changed or updated, and that it is specific to the practice. Screenshots and timestamps can be used to help evidence these facts.

III. Final Remarks:

Providers should save all electronic or paper documentation that supports attestation in order to ensure preparation for a potential audit. They should also save any documentation that supports the values entered in the attestation module for clinical quality measures. Hospitals should also maintain documentation that supports their payment calculations. If an audit happens, all of this documentation will be used to validate that the provider accurately attested and submitted clinical quality measures, as well as to verify that the incentive payment was accurate. Should you need assistance with a meaningful use

Robert W. Liles is a health care attorney experienced in handling prepayment reviews and audits.
Liles Parker attorneys represent health care suppliers and providers around the country in connection with regulatory compliance reviews, Medicare ZPIC and RAC audits, HIPAA Omnibus Rule risk assessments, privacy breach matters, and State Medical Board inquiries. Robert W. Liles, Esq., is a Managing Partner at Liles Parker, Attorneys & Counselors at Law.  Call Robert for a free consultation at 1 (800) 475-1906.