CMS meaningful use audits are in full swing

The Centers for Medicare and Medicaid Services are providing large amounts of incentives to hospitals and physicians who prove they are using electronic health records in a meaningful way. Because so many hospitals and physicians are using EHRs and taking advantage of the incentives, the CMS is performing audits to ensure that federal money is being spent properly, while independent sources are conducting studies regarding upcoding.

According to InformationWeek, the CMS is performing pre-incentive and post-incentive audits on 5 to 10 percent of health care providers. Some are chosen randomly and others are chosen based on risk profiles of suspicious or anomalous data.

"When you pay $21 billion for a government program, you have to conduct appropriate oversight," Robert Anthony of the CMS told InformationWeek at the Healthcare Information and Management Systems Society 2014 conference.

Setting an example
One reason for the CMS' caution is due to Detroit Medical Center. The hospital attested for meaningful use stage 1 in May 2011. The CMS paid DMC close to $33 million in incentives, according to Healthcare IT News. A lack of formulary alerts from the EHR system and differing quality measure denominators caused auditors to question the hospital's meaningful use qualifications.

"[DMC's parent organization] said they didn't like the way things were going," Leland Babitch, M.D., a former pediatrician at DMC, told Healthcare IT News, "and that led to my termination as CMIO at DMC. So the biggest unintended consequence of meaningful use, in my instance, was that I lost my job."

The CMS wanted up to $14 million in incentives repaid. After four to five weeks, the audit was finished and it concluded that DMC was not at fault for the problems. The hospital did not have to repay the incentives, but many physicians and other hospitals saw this audit as an example of what can happen.

The CMS is still searching for health care providers that do not adhere to the rules. There were suspicions that some hospitals were abusing EHR coding to receive more meaningful use payments, according to Modern Healthcare.

Are providers upcoding records?
The New York Times stated that hospitals received $1 billion more from Medicare reimbursements in 2010 than five years before. The article's analysis concluded that Medicare payments rose 47 percent between 2006 and 2010. However, a recent study, which was conducted by Ashish K. Jha, M.D., M.P.H., and Julia Adler-Milstein, A.P., published by Health Affairs, found no empirical evidence that hospitals are cheating EHRs to increase Medicare reimbursements.

"This [study] should offer everyone a little bit of reassurance, that we have not created this one, very important, potentially financially significant, unintended consequence. I think everyone has been worried about this," said Jha.

Prepare for an audit
The CMS will still audit 10 percent of providers who receive incentives this year and 10 percent more in 2015 until every organization is targeted. InformationWeek offered tips to hospitals and physicians who may be audited: Have good documentation and retain it for six years after attesting to meaningful use. Stage two of meaningful use requires providers to send patient care records for more than 50 percent of transitions of care or referrals. The numerators and denominators of this percent need to match the numbers submitted on the attestation form, according to InformationWeek. Discrepancies may occur if a provider accepts more patients before the audit begins. Another tip suggested is for hospitals or physicians to take dated screenshots that prove their ability to share EHRs with other health care providers that use different systems.

Health care organizations that attest to meaningful use should be prepared for an impending CMS audit at some point.