Healthcare News & Insights

CMS: 5% of EHR incentive applicants will be audited

The feds have announced some new details about upcoming audits of hospitals receiving payments for the meaningful use of electronic health records. 

158290002Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced it was adding a new round of meaningful use audits to enforce compliance with the federal EHR inventive program.

Previously, the feds were only slated to audit a group of healthcare providers who had already received incentive payments. However, the new initiative calls for audits of some organizations before they receive payment.

The questions most hospitals were asking: How many providers will be audited, and how will they be chosen?

CMS has revealed the answer to one of those questions, announcing that it plans to audit around one out of every 20 organizations that applied for the incentive program either before or after they receive payments.

As for what hospitals will be audited, CMS earlier said they would be selected at random as well as through a protocol used to pick out suspicious applications for the program. And while the agency didn’t reveal what would arouse suspicions, officials did say that two of the most common problems they’ve found so far have been:

  • Failures to conduct a data security risk assessment, and
  • A lack of adequate documentation for responses to some of the “yes or no” meaningful use criteria.

How to prepare

Pre-payment audits will be conducted starting with providers that have applied to the EHR incentive program starting in January 2013, according to guidance CMS posted on its website.

To get ready for a possible audit, hospitals must make sure they keep all of their supporting documentation after they apply for incentives. That includes documents that support cost calculations, as well as those that support the hospital’s claims of meeting meaningful use criteria, which must be kept in paper or electronic form for six years after the application.

In many cases EHR systems will be able to generate reports demonstrating that the meaningful use measures have been met. If a hospital is using a system without that capability, CMS says the organization must be sure to save all documentation that shows how the numbers were calculated for percentage-based measures.

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