Stage 2 MU Patient Engagement Validation May Cause Audit Issues

2014: CMS EHR Incentive Audit Risk – Patient Engagement and Portals

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

EHR meaningful use (MU) attestations for 2014 carry significant new challenges to successfully surviving a potential incentive audit. The name of the game for both Eligible Professionals (EPs) and Eligible Hospitals (EHs) is “patient engagement”.

2014 brings the first instance of Core MU measures that involve patient actions. That’s right, it will be necessary for some providers to motivate patients or else say goodbye to 2014 incentives. Patient data must be provided online to allow those patients to “view, download, and transmit” their health information. For EPs and EHs at Stage 1 if you don’t meet this Core requirement you can say good-bye to MU incentives for 2014. For EPs and EHs at Stage 2 you have the additional pleasure of making sure that least 5% of unique patients (or their authorized representative) who are seen or discharged during the reportable period actually access their portal data. It will be more than interesting to see how patients are lured to come to the portals. With so much at stake I expect we will see some creative workflows developed to achieve this Core measure.

And now we come to the topic of audits based on 2014 attestations. Since the portal activity measure is percentage based, validation might be a problem. Using a third party portal? How are you going to track patient activity and have it imported into your MU Dashboard? This could be especially tricky for hospitals that frequently select one vendor for their EHR and another vendor for their portal. The auditors are going to need to see credible documentation that backs up what is claimed during attestation.

2014 MU attestation is especially interesting since all providers, no matter what Stage of MU, only have to have a 3-month reportable period. For Stage 2 EPs and EHs I can imagine there could be some real pressure to attest as early as possible to achieve incentives. Always nice to get paid sooner rather than later. This desire to attest early could override the need to develop adequate and reproducible workflows that document patients have been going the portal. This is definitely a case where a measured approach is best. You don’t want to be in the position of trying to back pedal during an audit.

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: