HIMSS14: Updates on CMS Medicare Incentive Audits & Appeals

Majority of Failed Audits Tied to MU Measures and Security Risk Analysis

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

Last week found me in Orlando at the annual HIMSS conference sniffing out any information and news related to the CMS EHR Incentives programs and those pesky audits. Some of what I discovered is based on officially announced policy but there have also been a few tantalizing anecdotes from the field that hint at things to come. Let’s cut right to the chase. When we have more time I’ll tell you about my “fear and loathing” adventures at the HIMSS conference in Orlando. All you need to know for now is that being crushed in a escalator “mosh pit” at the airport or getting lost and walking all the way to Sea World at midnight is not my idea of fun. OK, on to the updates from HIMSS14.

Elizabeth Holland (director CMS’ Health IT Initiatives Group) and Robert Anthony (deputy director of CMS’ Health IT Initiatives Group) did a great job, as always, of covering the latest information about audits. Some items, like the details of what constitutes a “risk profile”, are not open for discussion. No surprise there. Here is what you need to know. The majority of failed audits occur either for lack of having documentation of the MU measures or the Security Risk Analysis. The focus continues to shift toward pre-payment audits. In the past few weeks a large wave of “limited” audits have been initiated, typically ask for one thing, documentation of certified technology.

I had a chance to speak with Ms. Holland (above) concerning the appeal process for those providers that have failed audits. There has been a perception that the appeal queue has a giant backlog with multi-month wait periods. Good to hear that the process has been streamlined and the turnaround time is down to a matter of weeks.

So where are we now in this whole process of Meaningful Use audits and appeals? Here is what I think. Enough time has now passed that all the major kinks have been worked out and the “system” can now handle the vast number of providers who will receive the audit “engagement” letter. At the HIMSS conference it was reported that over a recent period the incentive attestations have averaged over 2500 a day. At a 5% audit rate that translates to a minimum of 125 new audits a day. The good news is that I have been “behind the scenes” with enough providers going through the audit and appeal process to be confident that a predictable path based on consistency is now in place.

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 originally published at MeaningfulUseaudits.com.