Healthcare News & Insights

Feds launch new round of prepayment meaningful use audits

The Centers for Medicare and Medicaid Services (CMS) has responded to charges that the federal EHR incentive program lacks critical oversight by conducting audits of some providers after they attest to meaningful use of EHRs. 

A report from the Inspector General’s office of the Department of Health and Human Services (HHS) released late last year claimed that CMS wasn’t doing enough to verify that only eligible providers were receiving EHR incentives, making the programs too easy to defraud.

CMS relies on self-reported information from providers to determine which organizations are eligible for EHR incentive payments. The study found that CMS does correctly identify which providers meet meaningful use requirements based on their self-reported information — however, the agency doesn’t do much to verify the accuracy of that information. According to the report, CMS doesn’t have access to enough external data that could be used to verify self-reported information.

Another problem, according to the report: The only real control in place to stop ineligible providers from taking advantage of the program is a potential audit — but those audits don’t take place until after the provider has been entered into the program and payments have been made.

New meaningful use audits coming

It looks like CMS may have taken those criticisms to heart, as the agency recently announced it would start conducting prepayment meaningful use audits in the coming months. That’s in addition to the round of post-payment audits that was announced last summer.

What facilities will be subjected to the prepayment audits? CMS has said it will audit between 5% and 10% of providers who attested to meaningful use of EHRs. Providers will be chosen based on both random selections as well as a protocol used to pick out suspicious applications for the program.

Officials pointed out that providers still waiting to hear back about their attestations aren’t necessarily being audited — there’s currently a backlog in the approval process and many attestations are still being processed.

In order to get ready for a potential audit, CMS recommends providers save all the documentation that supports the data they submitted when applying for the EHR incentive program.

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