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CMS EHR Incentives Attestation-Audits-Appeals Focus on Hospitals

CMS EHR Incentives Attestation-Audits-Appeals Focus on Hospitals

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CMS EHR Incentives Attestation-Audits-Appeals Focus on Hospitals

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  1. CMS EHR IncentivesAttestation-Audits-AppealsFocus on Hospitals Jim Tate November 12, 2013 www.MeaningfulUseAudits.com

  2. Jim Tate • Founder EMR Advocate, Inc. • Managing Partner HITECH Answers • Author of The Incentive Roadmap® The Meaningful Use of Certified EHR Technology • Certified Technology – direct involvement in over 200 EHR certification projects • Subject Matter Expert to HHS/ONC: EHR Implementation • Specialist in Meaningful Use Audits & Appeals www.MeaningfulUseAudits.com

  3. Agenda Attestation Audits Appeals www.MeaningfulUseAudits.com

  4. Attestation • Accurate registration info • Appropriate meaningful use strategy • Look to vendor for guidance • Save all documentation • Make sure you attest www.MeaningfulUseAudits.com

  5. Attestation Save supporting electronic or paper documentation that support your attestation. Upon audit, the documentation will be used to validate that the provider accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate. www.MeaningfulUseAudits.com

  6. Audit Basics CMS, and its contractors, will perform audits on Medicare and dually-eligible Medicare/Medicaid providers. States, and their contractors, will perform audits on Medicaid providers. CMS and states will also manage appeals processes. www.MeaningfulUseAudits.com

  7. Who Gets the Audit? As of September, 2013 over 4,100 unique EHs CAHs have received CMS EHR incentives. CMS states over the aim is to audit 5%+. www.MeaningfulUseAudits.com

  8. What Generates the Audit? • Random • Suspicious Data • Patterns • Whistleblowers www.MeaningfulUseAudits.com

  9. The Audit Process • Letter • Request for Documentation • Response and Request • Final Determination www.MeaningfulUseAudits.com

  10. Audit – The Letter First contact will be an email from Figliozzi and Company from a CMS email address to the email address provided during registration for the EHR Incentive Program. www.MeaningfulUseAudits.com

  11. Audit – The Letter “This letter is to inform you that you have been selected by CMS for an audit of your meaningful use of certified EHR technology for the attestation period. Attached to this letter is an information request list. Be aware that this list may not be all-inclusive and that we may request additional information necessary to complete the audit.” www.MeaningfulUseAudits.com

  12. Final Determination – Good “We performed a desk review on your facility’s meaningful use attestation for the Program Year 2011 and Payment Year 1. Based on our desk review of the supporting documentation furnished by the facility, we have determined that Hospital XYZ has met the meaningful use criteria.” www.MeaningfulUseAudits.com

  13. Final Determination – Bad “We performed a desk review on your facility’s meaningful use attestation for the Program Year 2011 and Payment Year 1. Based on our desk review of the supporting documentation furnished by the facility, we have determined that Hospital XYZ has not met the meaningful use criteria, for the following reasons: Failed Eligible Hospital Meaningful Use Core Measure X. Since your facility did not meet the meaningful use criteria, the incentive payment will be recouped. You will receive a demand for your total Medicare EHR incentive payment shortly from the EHR HITECH Incentive Payment Center. The demand letter will include all information regarding the repayment process, and will also include your appeal rights.” www.MeaningfulUseAudits.com

  14. The Demand Letter “The purpose of this letter is to inform you that a Meaningful Use Audit determined a HITECH incentive overpayment in the amount of $X,XXX,XXX…..to be repaid to our office in full.” Full refund within 30 days.......Interest begins on 31st day…….Referred to Department of Treasury on 61st day Appeal status does not put interest penalties on hold. Even if you win on appeal the interest will still be due. www.MeaningfulUseAudits.com

  15. Appeals www.MeaningfulUseAudits.com

  16. Appeals • Nothing to lose • More flexibility than at the audit level • Less communication than during audit • Timeline of appeal process • Only failed MU measures addressed • Different reportable period is an option www.MeaningfulUseAudits.com

  17. Appeals • Do something different • Tell a story • Keep it simple • Leave the door open www.MeaningfulUseAudits.com

  18. Best Practices for Audit/Appeal • Have someone in charge • Establish contact with auditor • Watch the deadlines • Look to vendor for support • Seek counsel if needed www.MeaningfulUseAudits.com

  19. Q&A jimtate@emradvocate.com www.MeaningfulUseAudits.com 828.691.3239 www.MeaningfulUseAudits.com