EPs and EHs Audited for Meaningful Use

By Jim Tate, EMR Advocate
Meaningful Use Audit Expert
Twitter: @JimTate, eMail: audits@emradvocate.com

We have Steve Spearman of Health Security Solutions to thank. Through a Freedom of Information Act request, Steve obtained fascinating data on the number and identity of eligible hospitals (EH) and eligible professionals (EH) that had been audited for their CMS EHR Incentive attestations.

For providers undergoing an audit there is much on the table. If a Final Determination is made that meaningful use (MU) was not achieved and documented for the attestation under review, and that determination is not reversed by appeal, 100% of that incentive will be recouped. EHs can receive incentives over a number of years and it is not uncommon for a hospital to receive over $1,000,000 in a single year.

First, the disclaimers: The data we reviewed only covers Medicare and Medicare/Medicaid (dually-eligible EHs) audits. Since over 150,000 EPs are in the Medicaid incentive program, and since those audits take place on a state-by-state basis, we haven’t been able to examine those provider audits. The audit data is based on unique audits, not providers. The audit failures only tell us who failed an audit, not who had that failure reversed by appeal, or ultimately had their incentives recouped. Also, we don’t know the cut off time for the data. Steve made his FOIA act request in February 2014 and received the data 6 months later.

At a high level, here is the data:

  • 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%.

Comments: This is the first hard data on the volume of CMS EHR Incentive audits that I have seen. There has been anecdotal evidence of the significant amount of auditing but now we know it is all too true.

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? A small practice or clinic frequently does not have the ability to possess expertise on meaningful use, regulatory issues or the audit process. A hospital has staff solely dedicated to understanding and meeting the complex nuances of MU while a practice may not. I believe this is the reason the failure rate for EPs is so much higher than it is for EHs. I have to admit the difference in audit failure rates was tough to ponder. I think of all those EPs out there trying to figure out to document an electronic test of the state’s ability to receive an immunization message. Might be a good idea to refund the Regional Extension Centers and provide some targeted assistance for these folks. Just saying.

For more analysis on the audit data, I suggest you read Steve Spearman’s blog post on the topic.

Jim Tate is known as the most experienced authority on the CMS Meaningful Use (MU) audit and appeal process. His unique combination of skills has brought successful outcomes to hospitals at risk of having their CMS EHR incentives recouped. He led the first appeal challenge in the nation for a client hospital that had received a negative audit determination. That appeal was decided in favor of the hospital. He has also been successful in leading the effort to reverse a failed appeal, even after the hospital had received notification of the failure with the statement, “This decision is final and not subject to further appeal”. That “final” decision was reversed in less than a week. If you are a hospital with questions or concerns about the meaningful use audit process, contact him at: audits@emradvocate.com. This post was original published on MeaningfulUseAudits.com.