Meaningful Use and the Sin of Omission

Exclusion of Meaningful Use Public Health Measures – Focus on Eligible Hospitals

By Jim Tate, EMR Advocate
Meaningful Use Audit Expert
Twitter: @JimTate, eMail:

We’ve all faced the hard truth sometime in our lives and we’ve certainly heard the phrase over and over again. “The greatest regret is not for what we may have done, but for what we haven’t done”. In the past several weeks we has been involved in a number of EHR incentive audits, appeals, and mock audits for hospitals that unfortunately share a common theme echoed in those words. The stumbling block has been in the area of the exclusion of meaningful use (MU) public health measures claimed during attestation. There are legitimate reasons to exclude these measures. Maybe the hospital doesn’t perform the functions addressed by one of the measures. Maybe the regional registry can’t receive the electronic files. There could lots of valid scenarios that would pass muster for an exclusion.

During the attestations that took place in 2011 through 2013, and are currently within the scope of audits, there was more than enough confusion to go around. Some hospitals were told by their EHR vendor that their regional registry was not prepared to receive submission files. Sometimes that was accurate, sometimes it was not. I think you can see where I am headed. During an audit if you claim an exclusion to one of the public health MU measures, you need to be prepared to present documentation of supportive of that exclusion. If your regional registry could not receive electronic immunization files in 2011 and you claimed that exclusion, you need to be prepared to prove it.

Access to documentation has a funny was of disappearing into the ether over time. What might have been available in 2011 online about a registry’s functionality might be unavailable in 2014. We are working now with a few hospitals that didn’t locate the proper exclusion documentation in past years or simply did not know they needed it. There is a moral here somewhere, probably something about “sin of omission” or maybe even “a bird in the hand”.

If you have trouble locating this type of exclusion information don’t give up too quickly. We have found it located in such diverse places as online PowerPoint presentations, minutes of state health department meetings, and white papers in the “deep web”. Keeping looking until you find what is needed.

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: This post was original published on