Home Forums Discussions Meaningful Use MU Audits

Learned about this from HIStalk: as expected, Medicare is selectively auditing some people who received the MU incentive. More information is available here.

Jon,
Well it sure gives one pause about pursuing the MU incentive. Do you know if the penalty will be meted out to those not wishing to go after the MU money, if they have implemented an EHR such as AC?

Jimmie.
This is just an audit of a select few who have attested for MU. If you did not attest, there is no reason to think you will be audited. The legal firm posting the information downplays the concern about this: it "appear(s) to promise a very basic desk audit".
I didn't post it to alarm people, just so that we can be aware.

From reading through the "attorney-eze" on the page link that Jon supplied, it seems that the MU report that AC generates would provide the additional documentation that the auditors may require.

Jon,
I appreciate your posting of the link, and am not too alarmed, but just a bit leery. I am having an ethical dilemma with the affordable care act and watching the mounting debt of our country, and am really considering not collecting on the 3 stages of meaningful use. Oh, that's rational jimmie--by not taking the 44K you will single-handedly reduce our trillions of dollars of debt.

I do not fault any one for collecting on the money nor do I judge any one for doing so, but the question I need to further explore is that if one does not even attempt to attest for MU will there be some sort of penalty, and if so can I stomach it?

I have said this more than once, but started the EHR out of fear, so one could argue that I am a bit short sided, starting AC on 11/11/11, for the main reason to reduce any further penalties (as I am currently being penalized for not e-scribing by June 2011).

But I don't know if it is my pride or just being naive, but for me it just does not feel right to go after the 18K, unless there will be an additional penalty that may further jeopardize the cost of running the office.

I do not have a doubt that if I attested I would get the 18K and nearly have all the criteria met now for stage 1, but what I have been able to do since January with stabilizing overhead issues and improved charges/collections has really surprised me and in the long run will likely make the 44k(subtracting out the taxes) seem irrelevant.

So, can I stomach just saying no to this low lying,tempting fruit, because the fruit from my perspective is souring quickly on the tree.

an article from medscape on the articles:


From Medscape Medical News
CMS Audit Rattles EHR Bonus Recipients

Robert Lowes

Authors and Disclosures

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Review a study on sequential, mealtime injection approach which improved glycemic control in patients with type 2 diabetes and uncontrolled A1C (A1C≥7%) levels

Enter program

July 27, 2012 ? The US Centers for Medicare and Medicaid Services (CMS) is auditing ? and rattling ? an unspecified number of physicians and hospitals that have been awarded hefty incentive payments for meaningful use of electronic health record (EHR) technology.

The audited providers are receiving letters from a CMS contractor asking that they submit extra documentation within 2 weeks to support their claims that they met federal meaningful-use criteria. CMS will recoup bonuses from those who turn out not to have deserved the payments.

Although the audit is rather perfunctory, it has shaken up some providers who were caught off-guard, said attorney Joshua Freemire, whose law firm represents some of the physicians and hospitals that have received the letters.

"There appears to have been no advance announcements about the audit," said Freemire, an attorney at the Baltimore, Maryland, office of Ober/Kaler. "Some of our clients wondered if the letters were genuine, and if they should respond."

Freemire told Medscape Medical News that with past CMS audits of various kinds, the agency has given advance notice to the healthcare provider community and explained the audit's purpose and how many providers would be subject to it. "So when someone was audited, there wasn't panic or confusion," he said.

At the same time, physicians and hospitals should have known from the beginning of the incentive program that audits were theoretically possible, Freemire said. CMS is obligated to double-check that only deserving parties receive taxpayer dollars.

A section of the CMS Web site on the EHR incentive program addresses the subject of audits and advises providers on how to prepare for them. An Internet archive program indicates that this material was first posted online in March 2011.

The CMS contractor conducting the meaningful-use audit is Figliozzi & Company, a certified public accountant firm in Garden City, New Jersey. According to records posted on a federal Web site called Federal Business Opportunities, Figliozzi was awarded its contract in April. CMS is to pay the firm no more than $3,132,609.

A Frequently Asked Questions (FAQ) page on the CMS Web site states that Figliozzi & Company will audit individual clinicians who earned meaningful-use bonuses in the course of treating Medicare and Medicare Advantage patients. The firm also will audit bonus-winning hospitals serving Medicare patients and "dual eligibles" enrolled in both Medicare and Medicaid.

Letters from Figliozzi & Company will feature the CMS logo. CMS spokesperson Joe Kuchler said the agency submitted this FAQ information for posting in late June, about the same time that Figliozzi & Company began to mail audit letters to providers.

Some Providers Chosen Randomly, Some Not

The EHR incentive program, created by the economic stimulus legislation of 2009, awards up to $44,000 over 5 years under Medicare or up to $64,000 over 6 years under Medicaid to clinicians who use EHRs in specified ways to improve and streamline patient care.

Beginning in 2011 and through May 2012, CMS has awarded $5.8 billion in meaningful-use bonuses to providers, including $1.5 billion to roughly 82,000 physicians.

The attorney Freemire said the audit letter from Figliozzi & Company asks for 4 types of information that back up what providers reported to CMS to obtain their bonuses.

A copy of a document from the US Department of Health and Human Services that certifies the provider's EHR technology as eligible for the incentive program.
Documentation of reported emergency department admissions, a key number in calculating whether the provider met certain meaningful-use requirements.
Supporting documentation for a provider's claims to have satisfied mandatory meaningful-use objectives and measures, such as electronic prescribing.
Supporting documentation for a provider's claims to have satisfied voluntary meaningful-use objectives and measures.

Freemire said that the audit letter could have been more specific about the requested information. Nevertheless, he does not believe complying with the letter will be "terribly difficult," especially for physician practices with well-organized records.

The CMS Web site states that audited providers can pose questions to Figliozzi & Company by calling 516-745-6400 or emailing pfigliozzi@figliozzi.com.

Freemire characterizes the meaningful-use audit as "wide and shallow."

"We get the impression that a wide swathe of providers is getting letters," Freemire said. "They don't seem targeted and focused."

CMS spokesperson Joe Kuchler told Medscape Medical News that the agency is not disclosing the number or percentage of bonus recipients being audited. Providers were chosen "using various methods, including a risk-assessment process and other methods, such as random selections." Specific information about a provider also may trigger an audit, he added.

Physicians should not panic if an audit letter arrives in the mail, Freemire said. "Just identify the records and provide them."

an article on the audits--not articles--

I completed year 1 mu requirements and submitted in mid january 2013 for 90 day period from ending in december 2012. I patiently awaited the 6 weeks that someone on this board said that it would take to get a check. However, after waiting I did not receive a check but rather a notice letter that I was being audited for mu compliance. It took me a couple days but I submitted all of the requested documentation for the audit, now, over 4 more weeks have gone by -- and I wait. So far, this just seems like a tactic to delay payment. I'm curious whether anyone else has been through this process and how much longer I might expect to wait.

I attested for August to November 2011 for Year 1 MU and received the money 8 weeks later. I received my audit notice about two months ago, and had to submit multiple documents to clarify how I qualified, especially attestational statements. I still have not heard back from them as to whether I have satisfied the audit. So yes, they do pay, but yes, they do audit.

Another article on the audits from Medical Economics:

CMS conducting pre-payment audits before releasing 2013 EHR Incentive Program bonuses

Publish date: MAR 27, 2013

By: Rachael ZimlichIf

If you thought demonstrating meaningful use annually to receive electronic health record (EHR) incentive payments was enough, think again.

The Centers for Medicare and Medicaid Services (CMS) is performing pre-payment audits ?in addition to the post-payment meaningful use audits that started last summer?before mailing out some bonus checks. CMS says the audits affect a random sampling of 5% to 10% of incentive applications.

According to CMS, the pre-payment audits began with attestations submitted during and after January 2013, in addition to pre-payment edit checks already built in to the EHR Incentive Programs? systems. The audits may target suspicious data, says CMS, and providers selected for audits will have to provide data to back their attestation or validate their submitted data before CMS will release their bonus payment.

Providers selected for audits will receive a letter from CMS? contracted CPA firm, Figliozzi & Co. An initial review will follow, using data provided to CMS in a response to the audit notice from the provider. On-site reviews may follow in some cases and could include a demonstration of the provider?s EHR system. Any providers who are found to be ineligible for their bonus may initiate an appeals process, CMS says.

CMS says that out of 527,300 eligible professionals, 372,600 have registered for the EHR Incentive Program to date, with 17,532 registrations so far this year. Medicare-eligible physicians made up 11,714 of those registrations, and Medicaid-eligible physicians account for another 2,688. So far this year, no Medicare-eligible physicians have been paid their incentive payments, and 45 Medicaid-eligible physicians have been paid nearly $900,000 in bonuses. More than $12 million has been awarded so far for the 2013 program year to all eligible professionals, according to CMS.

One way to have a slight idea if you are going to be audited or not is to look at you credit history and score. If your credit is not so stellar, they look at you as a high risk for fraud. In any case, request your free annual report and chances are you will see that CMS looked at your credit.

If 'no Medicare-eligible physicians have been paid their incentive payments so far this year', it sounds like they are doing pre-payment audits on 100% of physicians who submitted after January 1, 2013 which underscores my suspicion that this is a payment delay tactic. I'm sure CMS will realize significant monetary savings just by giving already overwelmed physicians another deadline to potentially miss (I believe it was 30 days to submit the information for the pre-payment audit). I certainly hope I will not be subjected to a post-payment audit as well.

No Medicare-eligible physicians have been paid for the 2013 year because at the very least you need to attest for 90 days, and we have just past the 90 day point. Over $1 billion has been paid for 2012.

I understand your point re: payments for 2013 but my attesation was only filed in 2013 for a 90-day period beginning ending around 9/2012. I completed attesation in 1/2013 but because of the prepayment audit, I'm still waiting for the 2012 payment.

For year 2 MU, we're on the same boat and just finished pre-payment audit for the Amazing Charts' version 6 issue, showing proof of using version 6 prior to attestation date. Hopefully this concludes the audit for 2012 as our PQRS reporting already puts us beyond the "norm" bell curve.

Auditing seems to be CMS's current weapon.