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CMS EHR Incentives Attestation-Audits-Appeals Focus on Hospitals. Jim Tate November 12, 2013. Jim Tate. Founder EMR Advocate, Inc. Managing Partner HITECH Answers Author of The Incentive Roadmap ® The Meaningful Use of Certified EHR Technology

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cms ehr incentives attestation audits appeals focus on hospitals

CMS EHR IncentivesAttestation-Audits-AppealsFocus on Hospitals

Jim Tate

November 12, 2013

www.MeaningfulUseAudits.com

jim tate
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

agenda
Agenda

Attestation

Audits

Appeals

www.MeaningfulUseAudits.com

attestation
Attestation
  • Accurate registration info
  • Appropriate meaningful use strategy
  • Look to vendor for guidance
  • Save all documentation
  • Make sure you attest

www.MeaningfulUseAudits.com

attestation1
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

audit basics
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

who gets the audit
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

what generates the audit
What Generates the Audit?
  • Random
  • Suspicious Data
  • Patterns
  • Whistleblowers

www.MeaningfulUseAudits.com

the audit process
The Audit Process
  • Letter
  • Request for Documentation
  • Response and Request
  • Final Determination

www.MeaningfulUseAudits.com

audit the letter
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

audit the letter1
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

final determination good
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

final determination bad
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

the demand letter
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

appeals
Appeals

www.MeaningfulUseAudits.com

appeals1
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

appeals2
Appeals
  • Do something different
  • Tell a story
  • Keep it simple
  • Leave the door open

www.MeaningfulUseAudits.com

best practices for audit appeal
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

slide19
Q&A

jimtate@emradvocate.com

www.MeaningfulUseAudits.com

828.691.3239

www.MeaningfulUseAudits.com