CMS Provides Additional Insight into EHR Incentive Audits and Appeals
Says EHR Incentive Audits Will Increase in 2014
CMS this week (1/28/2014) sponsored a “2014 EHR Meaningful Use Webinar”. Covered during the session were the “usual suspects” that included meaningful use, timelines, and hardship exemptions for the upcoming potential fee adjustments. A few slides buried near the end of the presentation provided insight into the ongoing EHR incentive audits and appeals process. Here are a few facts I found most telling, along with my commentary.
- “Post-payment audits began in July 2012, and will take place during the course of the EHR Incentive Programs.” Its not over until its over.
- “CMS began pre-payment audits this year, starting with attestations submitted during and after January 2013.” I’ve been seeing more of these pre-payment audits. Also, seeing more “limited audits”.
- “5-10% of providers subject to pre/post-payment EHR incentive audits.” Affirmation of the wide net being cast.
- “If a provider continues to exhibit suspicious/anomalous data, could be subject to successive audits.” This had been suspected but now it is clear that an audit failure could make a provider more likely to be audited again.
- “In order to ensure robust oversight, CMS will not be making the risk profile public”. CMS will not be providing any clues as to the logic behind the selection of those providers who are audited based on an established risk profile.
- “CMS cannot: Discuss issues or circumstances related to specific audits of actual providers (e.g., One of my providers failed the audit and shouldn’t have… ). Provide information regarding protocols used by audit contractor (e.g., What raises a “red flag” for auditors?, What information will auditors ask for? ,etc.). Resolve issues related to specific audits—Providers must use the appeals process if they believe they received an incorrect adverse audit finding.” It is obvious that after a failed audit many providers continue to attempt to communicate with the auditors for clarification or in hopes of reopening the audit. CMS is clearly stating that if a provider receives a negative determination, the only potential next step is the filing of an appeal.
Speaking of appeals; CMS has updated both the appeal forms and process for Eligible Hospitals and Eligible Professionals. Links to both are available below: