Monthly Archives: August 2012

Bait and Switch: Medicare Audits Physicians Who Take Advantage of Incentive Payments for Electronic Health Records

The US Centers for Medicare and Medicaid Services (CMS) has advertised and encouraged physicians across the country to take advantage of incentive payments in order to upgrade their offices for meaningful use of electronic health records (EHR) technology.

Government and private payers are seeking to have such EHR technology more standardized and many healthcare experts expect that EHR systems will be required to participate in government and private payer systems.   Reports from physicians about the incentive program have not been complimentary, with many physicians complaining that funding has been slow in coming.

Now, may providers who took advantage of the incentive payments are being audited.  Many have received letters from a CMS contractor asking that they submit extra documentation within 2 weeks to support their claims that they met federal meaningful-use criteria. CMS will recoup bonuses from those who turn out not to have deserved the payments.  While the regulations have always provided that such audits were possible, the audits are still surprising many physicians. See this CMS link for audit regulation information.

The audit letter from Figliozzi & Company asks for 4 types of information that back up what providers reported to CMS to obtain their bonuses.

  • A copy of a document from the US Department of Health and Human Services that certifies the provider’s EHR technology as eligible for the incentive program.
  • Documentation of reported emergency department admissions, a key number in calculating whether the provider met certain meaningful-use requirements.
  • Supporting documentation for a provider’s claims to have satisfied mandatory meaningful-use objectives and measures, such as electronic prescribing.
  • Supporting documentation for a provider’s claims to have satisfied voluntary meaningful-use objectives and measures.

Submitted by Matthew L. Kinley