This article is written by Zubin Emsley, CEO, ChartLogic Inc. On July 24 the Centers for Medicare and Medicaid Services (CMS) confirmed that it has hired a Garden City, N.Y., accounting firm, Figliozzi & Company, to begin auditing physicians and hospitals that have qualified for Medicare EHR meaningful use (MU) incentives. While the CMS announcement did not say how many providers will be audited, a separate report issued in April by the Government Accounting Office (GAO) on the incentive program suggested that 10 percent of hospitals and 20 percent of physicians who attested under the Medicare MU program should be audited.
According to the Washington, D.C.-based law firm of Ober Kaler, which maintains a large healthcare practice, several of its clients (both hospitals and physicians) have already received letters from Figliozzi requesting an audit. The law firm has written a public report, available here about what to expect in an audit.
Based upon the CMS and GAO documents and the Ober Kaler alert, here are five steps for orthopedic practices that have received meaningful use incentive payments to take.
1. Be prepared, but don’t panic. The letters received by physicians in the last week asked for information and documents and gave them two weeks to comply. The Ober Kaler advisory noted these are "desk audits," requests for documents to back-up filings already made. To date, there is no evidence that auditors will visit organizations on site.
Since more than 52,000 physicians have attested under the Medicare program so far, a 20 percent audit rate would mean examining at least 10,000 individual record sets – a very ambitious goal for one accounting firm. Also, the CMS has said there will be an appeal process set-up in the near future.
2. One of the main goals of the audit is to verify that providers actually own the certified software they attested to having. Contact your EHR vendor and ask for their certification number and documents verifying your ownership of their system. CMS said Medicare providers should also produce patient rosters, EHR screenshots and reports generated by the EHR.
3. If your practice claimed an exemption to one of the mandatory MU attestation measures, be prepared to support your claim with documents. The GAO report said 72 percent of all reporting physicians claimed at least one exemption from a core measure.
The GAO report also called attention to the fact that many attesting physicians calculated clinical measures based on a very low number of patients, often less than seven. This low number made them statistically unreliable (although not necessarily inaccurate).
Also, providers may need to account for patients whose records are maintained outside the EHR. The auditor may also ask for documentation of the required "test" of information exchange with another provider or a public health entity.
4. In addition to documenting various EHR attestation elements, the auditor may ask you to prove that your EHR is currently in regular use by your physicians. Also, the audit may include a request to document the health information privacy and security assessment that is required under MU attestation procedures.
5. Many questions remain about who is most likely to be audited, what exactly the auditors will look for, and the implications of an adverse finding. The CMS has given out very little information so far; they do provide a short description of the audit process here. Also, you can download the PDF version of the GAO Report, which describes how the audit process should be conducted.
ChartLogic Inc. is a leading provider of EHR systems for specialist physicians. For more information see www.ChartLogic.com
According to the Washington, D.C.-based law firm of Ober Kaler, which maintains a large healthcare practice, several of its clients (both hospitals and physicians) have already received letters from Figliozzi requesting an audit. The law firm has written a public report, available here about what to expect in an audit.
Based upon the CMS and GAO documents and the Ober Kaler alert, here are five steps for orthopedic practices that have received meaningful use incentive payments to take.
1. Be prepared, but don’t panic. The letters received by physicians in the last week asked for information and documents and gave them two weeks to comply. The Ober Kaler advisory noted these are "desk audits," requests for documents to back-up filings already made. To date, there is no evidence that auditors will visit organizations on site.
Since more than 52,000 physicians have attested under the Medicare program so far, a 20 percent audit rate would mean examining at least 10,000 individual record sets – a very ambitious goal for one accounting firm. Also, the CMS has said there will be an appeal process set-up in the near future.
2. One of the main goals of the audit is to verify that providers actually own the certified software they attested to having. Contact your EHR vendor and ask for their certification number and documents verifying your ownership of their system. CMS said Medicare providers should also produce patient rosters, EHR screenshots and reports generated by the EHR.
3. If your practice claimed an exemption to one of the mandatory MU attestation measures, be prepared to support your claim with documents. The GAO report said 72 percent of all reporting physicians claimed at least one exemption from a core measure.
The GAO report also called attention to the fact that many attesting physicians calculated clinical measures based on a very low number of patients, often less than seven. This low number made them statistically unreliable (although not necessarily inaccurate).
Also, providers may need to account for patients whose records are maintained outside the EHR. The auditor may also ask for documentation of the required "test" of information exchange with another provider or a public health entity.
4. In addition to documenting various EHR attestation elements, the auditor may ask you to prove that your EHR is currently in regular use by your physicians. Also, the audit may include a request to document the health information privacy and security assessment that is required under MU attestation procedures.
5. Many questions remain about who is most likely to be audited, what exactly the auditors will look for, and the implications of an adverse finding. The CMS has given out very little information so far; they do provide a short description of the audit process here. Also, you can download the PDF version of the GAO Report, which describes how the audit process should be conducted.
ChartLogic Inc. is a leading provider of EHR systems for specialist physicians. For more information see www.ChartLogic.com