Meaningful Use Survivor: 4 Steps to a Successful Audit

1. Patient volume
Risk Analysis
Patient Reminders
Valid license to
practice
CDSR
Meaningful Use Survivor:
Four Steps to a Successful Audit

2. Mary Givens, Chief Contributor to
www.MUforBH.com, the only meaningful use
resource developed specifically for the
Behavioral health EP. Also the Meaningful Use
Manager at Qualifacts Systems, Inc.
Karyn Krampitz
Director, Professional Learning Center
The Coalition of Behavioral Health
Agencies, Inc.
90 Broad St., New York, NY 10004
212.742.1600 x103 office
kkramp! itz@coalitionny.org
www.coalitionny.org
Introduction of the Speakers

3. Agenda
Topic
Audit Program Overview
Topic
Audit Program Process
Topic
Create an Audit trail
Topic
Summary of the Four Steps

4. CMS FAQ7711
(https://questions.cms.gov/faq.php?id=5005&faqId=7711)
Any provider attesting to receive an EHR incentive payment for either the
Medicare or Medicaid EHR Incentive Program potentially can be subject to
an audit. Here's what you need to know to make sure you're prepared:
Overview of the CMS EHR Incentive Programs Audits
• All providers attesting to receive an EHR incentive payment for either the Medicare
or Medicaid EHR Incentive Programs should retain ALL relevant supporting
documentation (in either paper or electronic format) used in the completion of the
Attestation Module responses. Documentation to support the attestation should be
retained for six years post-attestation. Documentation to support payment
calculations (such as cost report data) should continue to follow the current
documentation retention processes.

5. Audit Program Overview
• Medicare EHR Incentive Program participantsCMS, and its contractors, will perform audits on Medicare
and dually-eligible Medicare/Medicaid providers.
• Medicaid EHR Incentive Program participantsStates, and their contractors, will perform audits on
Medicaid providers. Variability among the States.
• CMS/State Medicaid can audit for up to six years
following participation in MU program.
• Appeals Process-CMS and each individual state will also
manage appeals processes.

6. Audit Program Process
Checks built into the attestation process to detect inaccuracies
in eligibility, reporting and payment.
Pre-payment and post-payment audits are underway.
If a provider is found to not be eligible for an EHR incentive
payment, the payment will be recouped.
CMS has implemented an appeals process for EPs, EHs, and
CAHs that participate in the Medicare EHR Incentive Program.
States will implement appeals processes for the Medicaid EHR
Incentive Program. For more information contact the State
Medicaid Agency.

7. Audit Program Process
What triggers an Audit?
Random
Suspicious data
Whistleblowers

8. Audit Program Process
Who will be audited?
• As of July 2013 over 290,000
unique EPs and 4,000 unique
EHs have received Medicare
incentives.
• CMS states the aim is to audit
5% - 10% of participants.

9. Audit Program Process
The Audit Process
The Letter
The Request for Documentation
Response and Request
Final Determination
Appeal Process

10. Audit Program Process
If the EP is selected:
• If an EP is selected for an audit, the first contact will be an
email to the email address provided during the registration
at CMS.
• The auditing entity will request supporting documentation
(paper or electronic) to support the EPs attestation.
• Proof of possession of a certified HER
• Evidence (audit package) to support each of the
measures attested to including evidence if exclusion
where relevant.
• Proof that the security risk analysis was conducted
during the reporting period and if deficiencies were
identified, the plan of correction to address these
deficiencies, including target completion dates.
• Report for clinical quality measures.

11. Audit Program Process
Response and Request:
• Submitted
documentation will be
reviewed by the auditing
entity and, if
necessary, there will be a
request of additional
information or request
for greater clarification.

12. Audit Program Process
Final Determination - Good
“We performed a desk
review on your facility’s
meaningful use attestation
for the Program Year 2011
and Payment Year 1. Based
on our desk review of the
supporting documentation
furnished by the facility, we
have determined that
Hospital XYZ has met the
meaningful use criteria.”

13. Audit Program Process
Final Determination - Bad
“We performed a desk review on your facility’s
meaningful use attestation for the Program Year 2011
and Payment Year 1. Based on our desk review of the
supporting documentation furnished by the facility, we
have determined that Hospital XYZ has not met the
meaningful use criteria, for the following reasons: Failed
Eligible Hospital Meaningful Use Core Measure X. Since
your facility did not meet the meaningful use criteria, the
incentive payment will be recouped. You will receive a
demand for your total Medicare EHR incentive payment
shortly from the EHR HITECH Incentive Payment Center.
The demand letter will include all information regarding
the repayment process, and will also include your appeal
rights.”

14. State Medicaid Audit Processes
State to state, process will vary
• The exact audit process will vary from state to state. The
following slides should give you a general understanding of what
the process might be like.
• At the end of this presentation, we have provided you with the
links for many sources of information on audits, including as
many state specific audit links as we could find.
• You can assume each state will conduct pre payment audits as
well as post payment audits on the following:
• Provider eligibility
• Incentive payments for
• Demonstration of A/I/U
• Meaningful Use of certified EHR Technology

15. State Medicaid Audit Processes
Overview
•
Medicaid EHR Incentive Program audits are conducted to detect
fraud, abuse, or waste of Medicaid dollars.
•
Each state that chose to participate in the Medicaid EHR Incentive
Program has a Health Information Technology (HIT) plan that
was approved by CMS prior to that state being able to initiate
their state Medicaid EHR Incentive Program.
• Each of these state HIT plans includes the state’s
policies and procedures to ensure that the EHR
Incentive payments are issued properly and to
prevent fraud and abuse (The State’s Audit Strategy).

16. State Medicaid Audit Processes
Pre-Payment Validations
When an EP attests in the State Medicaid EHR system for a particular
calendar year, he is attesting to the accuracy of that submission.
• Before the state releases an incentive payment, it will perform an
analysis of the information to verify that it is consistent with state data.
• This process ensures that the provider completed the application
correctly and accurately and allows for addressing any problems
prior to the issuance of the incentive payment.
• The process may utilize a combination of automatic and manual
validation steps.
• Each state will also leverage the existing controls built into the
Medicaid enrollment and reimbursement process for items such as
Medicaid enrollment status and sanctions or exclusions.
• If the state finds a discrepancy or has questions, they will contact the
Eligible Professional and ask for additional information and/or
documentation.
•

17. State Medicaid Audit Processes
Post Payment Audits
• Eligible professionals should be aware that all
information submitted during
registration, attestation, supplemental materials, and
any subsequent validation and audit procedures must
be backed by auditable data sources or
documentation.
• In light of the possibility of post-payment
audit, providers are required to retain documentation
in support of all attestations for no fewer than six
years after each payment year.

18. Audit Program Basics
Create an Audit Trail
• Medicaid EP Eligibility:
• Retain all documentation used to determine the
eligibility of the provider who chooses to participate in
the program.
• Copy of the CMS registration receipt for each Eligible
Professional (EP)
• Evidence of valid credential, valid license, and active
individual Medicaid ID number at time of attestation
• Document verification that provider is non hospital
based at time of attestation
• Evidence that EP agreed to assign incentive dollars
to your agency.

19. Audit Program Basics
Create an Audit Trail
• EP Patient Volume- Clearly document the
process used for calculating patient volume so that
the report can be recreated.
• This includes defining the formulas and /or
queries used for the calculation.
• If the BH EP used encounters that were
delivered as part of a fixed rate per day
program for his/her patient volume
calculation, be sure to retain evidence of those
encounters.
• Be prepared to demonstrate and have evidence
of how it is established that the patient was a
Medicaid participant on the day the billable
service was delivered.

20. Create an Audit Trail
• EP Measures:
• Retain all paper or electronic format documents used in the
completion of each of the attestation modules. This could include
but is not limited to
• For percentage based measure, copy of the EP Measure report
or dashboard
• For non percentage based measures, retain any screenshots or
other evidence
• For risk analysis measure, retain copy of the risk analysis
completed during reporting period.
• For exclusions EP must also retain evidence.
** Upon audit, the documentation will be used to validate that the
provider accurately attested and submitted CQMs, as well as to
verify that the incentive payment was accurate.

21. Create an Audit Trail
• Primary documentation that will be requested is the source
document(s) that the provider used during attestation.
• This document should provide a summary of the data that supports the
information entered during attestation. Ideally, this would be a report
from the certified EHR system, but other documentation may be used if
a report is not available or the information entered differs from the
report.
• This summary document will be the starting point of most reviews
and should include, at minimum:
•
• The numerators and denominators for the measures
• The time period the report covers
• Evidence to support that it was generated for that eligible professional.
Although the summary document is the primary review step, there could
be additional and more detailed reviews of any of the measures, including
review of medical records and patient records. The provider should be able
to provide documentation to support each measure to which he or she
attested, including any exclusions claimed by the provider.
Source: https://questions.cms.gov/faq.php?id=5005&faqId=7711

22. Some examples of the types of
documentation that might be expected
•
•
•
•
•
Measures Drug-Drug/Drug-Allergy Interaction Checks and Clinical Decision Support –
Proof that the functionality is available, enabled, and active in the system for the
duration of the EHR reporting period.
Measure Electronic Exchange of Clinical Information – Screenshots from the EHR
system or other documentation that document a test exchange of key clinical
information (successful or unsuccessful) with another provider of care. Alternately, a
letter or email from the receiving provider confirming the exchange, including specific
information such as the date of the exchange, name of providers, and whether the
test was successful.
Protect Electronic Health Information – Proof that a security risk analysis of the
certified EHR technology was performed prior to the end of the reporting period
(e.g., report which documents the procedures performed during the analysis and the
results).
Drug Formulary Checks – Proof that the functionality is available, enabled, and active
in the system for the duration of the EHR reporting period.
Exclusions – Documentation to support each exclusion to a measure claimed by the
provider.
Source: https://questions.cms.gov/faq.php?id=5005&faqId=7711

23. Sample of some “Prepare for Audit”
Tools available
In the next couple of slides we will
look at a couple of tools
developed from other sources to
be used to prepare for an audit-

24. *The South Florida REC put out a “Meaningful Use EHR Incentive Program Audit Defense
Documentation” checklist that sites “recommended items each provider should complete in
order to thoroughly document Meaningful Use attestation.” Lets look at part of this list
*http://www.southfloridarec.org/publications/pdfs/Meaningful_Use_EHR_Incentive_Payment_Checklist.pdf

25. Louisiana Medicaid has contracted with Myers and Stauffer LC, an audit firm to review the
incentive payments in the LA Medicaid EHR Incentive Program. LA CONNECT published an
**“Audit Tips for Eligible Professionals” document.
Below is some of the context from this tool-
http://dhh.louisiana.gov/assets/medicaid/docs/laconnect/EPAuditReviewTips.pdf

26. The Illinois Health Information Technology Regional Extension Center (IL HITREC) created a
document called, *** “A Meaningful Use Audit Reference Guide: Suggested Documentation to
Keep After Attestation”. Let’s look at some of the advice included in this document-
*** http://www.ilhitrec.org/ilhitrec/pdf/ILHITREC%20CMSAuditGuide%20Info_4.15.13.pdf

27. Four Steps to a Successful Audit
1. Identify who will manage the audit
2. Establish contact with the auditor
3. Comply with the deadline
4. Seek vendor support

28. Questions?

29. DISCLAIMER:
Please remember
We do our best to provide you with the most accurate information
possible, but it is ultimately your responsibility to fully understand and
comply with the final rules and regulations of the Medicaid and Medicare
EHR Incentive Programs.
We highly recommend each individual consult the CMS website and the
state-specific Medicaid EHR Incentive Program website to confirm the rules
and requirements.
Under no circumstances shall anyone associated with www.MUforBH.com
of Qualifacts Systems Inc. Be liable for any
incidental, indirect, consequential or special damages or loss of any kind
including those resulting from the expected incentives themselves.
It is important that each Eligible Professional note that CMS views the EP
as ultimately responsible for the numerator and denominator and their
Medicaid Encounter volume as well as the data used for attestation on the
measures of Meaningful Use.

30. IMPORTANT LINKS
www.emradvocate.com
www.hitechanswers.net
www.MUforBH.com
CMS Guide to the States, “Medicaid EHR Incentive Program Audit Strategy
Toolkit”, (revised 1/13)
CMS Audit, “What Providers Need to Know about EHR Audits”
Why is Making Meaningful Use Audits a Priority Necessary
AAFP, “How to Prepare for, Survive an EHR Meaningful Use Audit:
Government Expert Provides Tips.”
HIMSS, “The Summer Olympic Games Have Begun as Have
the EHR Meaningful Use Incentive Audits”

31. Some State Specific Audit Resource LINKS
Colorado State Medicaid HIT Plan-includes audit information
Kentucky Medicaid EHR Incentive Program Eligible Professional
Meaningful Use Attestation Manual
New Jersey Audit Process Web Page
New York Medicaid EHR Incentive Program Integrity and Audit
Guidelines
North Carolina Medicaid Electronic Health Record (EHR) Incentive
Program Audits
Pennsylvania EHR Incentive Program Audits
Oregon Medicaid Electronic Health Records Incentive Program
Rulebook Division 165 (Audit Information Starts on page 6)
Wisconsin: WHITEC Meaningful Use Attestation and Audit Preparation

32. Some State Specific Audit Resource LINKS
Virginia : How to Prepare you Practice for Meaningful Use
Louisiana: LA Connect Audit Tips for Eligible Professionals
Illinois HITEC REC : A Meaningful Use Audit Reference Guide:
Suggested Documentation to Keep After Attestation”
Tennessee Audit Information
http://www.tn.gov/tenncare/ehr_ProgramIntegrity.shtml
South Florida REC Meaningful Use Attestation Audit Defense
Documentation Recommendations
http://www.southfloridarec.org/publications/pdfs/Meaningful_Use_EHR_
Incentive_Payment_Checklist.pdf
Georgia “Tips for Eligible Professionals Selected for Post Payment
Review of the Georgia Medicaid Electronic Health Record Incentive
Program Payment”

33. Some State Specific Audit Resource LINKS
Texas EHR Incentive Program: Appealing an Audit Finding
http://www.tmhp.com/News_Items/2013/09Sept/Audit%20Appeal%20Process.pdf
Texas EHR Incentive Program : Auditing and Supporting Documentation
http://www.tmhp.com/News_Items/2013/04Apr/Audit%20and%20Supporting%20Documentation_April%202013_Final.p
df
Idaho EHR Incentive Program Payments Audit
http://healthandwelfare.idaho.gov/default.aspx?TabId=1405

34. Contact Me
Mary Givens, Chief Contributor to
www.MUforBH.com and Meaningful Use
Manager at Qualifacts Systems, Inc.
Email Mary at
meaningfuluse@qualifacts.com
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