Death, Taxes and Meaningful Use Audits Medical Record Services, LLC Mark Norris 10/16/14

Here Come the Numbers: Data on Meaningful Use Audits October 7, 2014 Eligible Hospitals: Over 650 audits of which 613 had been completed. The failure rate is 4.9% Eligible Professionals: Over 10,000 unique audits initiated and over 8,000 have been completed. The fail rate is 21.9%. There is a disturbingly higher percentage of audit failures by EPs than by EHs. The audit fail rate is over 450% higher. Why is this?

Pre-Payment Audits of Eligible Providers As of September 16, 2014, Figliozzi & Co., the contractor responsible for performing MU audits on behalf of the Centers for Medicaid and Medicare Services (CMS), had undertaken a total of 5,825 pre-payment audits. This pre-payment audit program is relatively new (started within the past two years), so the volume of EP already assessed is surprising. Of those, 3,820 audits, or 65.6% of the total have been completed. That means there are currently more than 2,000 pre-payment audits in progress at the moment.

While a vast majority of those assessed were found to have appropriately attested, nearly a quarter (821 or 21.5%) of EP subjected to pre-payment audits did not meet meaningful use standards. CMS provided two reasons for failing to meet meaningful use: failure to use a certified EHR and failure to meet MU objectives and associated measures. The bulk of those EP that failed audits (92.9%) did not meet the appropriate objectives and associated measures. Only 7.1% of those audited failed to use a certified EHR when attesting.

Post-Payment Audits of Eligible Providers From the time MU post-payment audits began, 4,780 eligible providers have been assessed after the payment of incentives. This number is, unexpectedly, smaller than the number of pre-payment audits that have been initiated by CMS. Of those post-payment audits, 4,601 or 96.3% have been completed.

As with pre-payment audits, almost a quarter (1,106 or 24%) of EP failed to meet meaningful use standards. CMS provided the same two reasons for failure to meet meaningful use: failure to use a certified EHR and failure to meet objectives and their associated measures. Most of those EP that failed their audits (98.9%) did not meet the appropriate objectives and associated measures.

Along with information on the number and type of audits, the report included the proposed amount of incentive payment returned to CMS by those eligible providers who failed meaningful use audits. These numbers ranged from $41.92 to $19,800 per provider. The average returned incentive payment was $16,862.81. It is important to note that providers who fail MU post-payment audits are able to appeal the audit outcome. If their appeal is successful, these EP are not required to return incentive payments. The data obtained from this report concerning returned incentive payments reflects the suggested incentive payment return prior to an appeal. For eligible providers counting on incentive payments to cover EHR start-up costs and associated business expenses, returning thousands of dollars could be devastating.

Post-Payment Audits of Eligible Hospitals The final portion of information included in the report contained information on post-payment audits of eligible hospitals. The number of post-payment audits performed was 651. This number is significantly smaller than the number of eligible providers that have been audited, but reflects the smaller number of attesting hospitals as compared to individual eligible providers. Just over ninety-four percent (94.2%) of those 651 audits have been completed. Of those completed, only 4.7% (29) of EH failed post-payment audits. This is a significantly smaller ratio of failure to success than both pre- and post-payment audits of eligible providers.

CMS did not include information on the reasons for EH audit failure but did include amounts for potential returned incentive payments. As with post-payment audits of eligible providers, these numbers reflect proposed returns prior to any audit appeals filed by eligible hospitals. Potential returned incentive payments ranged from $280,414 to $3,430,591.20 with an average of over a million dollars returned from eligible hospitals ($1,132,937.22). Overall incentives returned to CMS following post-payment audits total nearly $33 million dollars.

How do you become audit proof? Documentation Requirements • 50% and 80% rule • Meaningful Use Reports • Screenshots • Privacy and Security Requirement What can raise a flag? Best Practices

The Audit Process • Pre-payment checks are built into the Medicare and Medicaid Incentive Programs to detect inaccuracies in eligibility, reporting, and payment • Post-payment audits will be completed during the course of the Medicare and Medicaid Incentive Programs • If an auditor finds the provider not eligible for an incentive payment, the payment will be recouped • CMS has an appeals process for eligible providers and hospitals that participate in the Medicare Program • Each state will implement an appeals process for the Medicaid Program

Medicare • Figliozzi & Company • Performs all audits for the Medicare EHR Incentive Program • Has a 3-year contract with CMS • Started in July 2012 • If you are selected for an audit, you will receive a letter from Figliozzi & Company with a CMS logo

Initial Information Request The following information will be included in the initial request from the auditor • Proof of possession (Invoice, License agreement) – Version Number • Documentation for 50% rule (If the provider works at multiple practices) • Documentation for 80% rule (If providers maintain records outside the EHR) • CEHRT reports • Documentation to support the “Yes/ No” measures (within a stipulated time period)

Follow-Up After the initial review process, you may receive a follow-up letter • Auditors may require for additional documentation • Clarification of provided documentation

50% Rule “We proposed that to be a meaningful EHR user an EP must have 50 percent or more of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with Certified EHR technology” -Page 44329, Stage 1 Final rule • Providers may be requested to prove this, especially if they are practicing in multiple practices • Reports from Practice Management System, Billing from all practices can be used to prove this

80% Rule The Denominator for Medication List, Allergy List and Problem List – All Unique Patients • Requires more than 80% of the provider’s patients to be in the Certified EHR • Providers can prove this by providing documentation from Practice Management System, Patient Roster, Billing system, etc

Reports Important Points About Meaningful Use Reports • Save a hard copy of the MU report • Reports may not show the same numbers after a year • Auditors request for dashboards with the vendor’s logo, Provider’s name, reporting period • Save a hard copy your CQM reports