Communique from the Beach - by Jim Tate EMR Advocate

EMR Advocate Newsletter

by Jim Tate

August 2013

 

Communique from the Beach

Summer is almost gone. My kids start school next week. Time for one last trip to the beach. "The windy beach, far from the twisted reach of crazy sorrow" as Dylan proclaimed. Even here, beneath the diamond skies of Coral Bay on St. John Island, I am not beyond emails informing me of the latest developments pertinent to CMS EHR Incentive audits. 

In between snorkel trips to Trunk Bay and Salt Pond Beach I find disturbing emails lurking through my inbox. Of course, there are the standard inquiries I've received from eligible professionals who are being audited and don't stand the slightest chance of passing an audit. There is the dermatologist who swears he was told there was no minimum number of patients he had to document in his ONC certified EHR to receive an $18,000 incentive in 2011. He received the infamous "audit engagement letter" letter last week. I asked him how many patients he saw during his 2011 meaningful use period and he answered, "Hundreds". I asked him how many patients did he record in his EHR? "Six" was the reply. My advice? Do not pass Go, do not go through the audit, do not appeal. Pay the money back and go and sin no more. Those are the easy, black and white answers. However, I have also be running across some issues with those touchy nuances pertaining to the often foggy "public health" measures.

The Public Health (PH) measures have been slightly off the radar as they swish and sway down there in the Menu Measures for Eligible Professionals (EP) and Eligible Hospitals (EHs). Such Menu Measures as Immunizations, Syndromic Surveillance, and Reportable Lab Resultscontinue to confuse and confound. Wouldn't it be nice to pick one, claim an exclusion, and then be rid of it hopefully for all time? Just throw it over the fence and forget about it. These PH measures and the attestation strategies employed by both EPs and EHs are now starting to bear bitter fruit. I am working with a number of providers undergoing audits for their 2011 attestation in which the core area of concern is focused on the PH measures. Often the person that planned and carried out the 2011 attestations has moved on and there is no paper trail to document the logic behind the decisions as to which Menu Measures were chosen. If that wasn't enough, a thorough audit will want documented proof supporting an exclusion claim. You say your state was unable in 2011 to receive immunizations electronically? Fine, provide that documentation to your auditor and move on. If you can't, well you can see why this is a sticky area. For an EP this could be the tipping point between keeping or giving back that long gone $18,000 incentive. For an EH the stakes are much, much higher. We are talking millions here.

  

I'm thinking there were a lot of attestations that were just thrown together in 2011. There was so much money on the table. I can imagine the pressure that came from those at The Top to "Get those incentives!" Who wouldn't want to make the boss happy with the news that the attestation was successful and the check was on its way? Tell the CEO, the CFO, and the Board, "It's all good". I haven't talked to too many of those happy folks. The ones that contact me are the ones who are undergoing an audit or have failed one. The ones that are trying to piece together the what, how, and why that occurred two years ago. They ones sent in with mop and bucket to clean up the mess. Contact me here if you need help. Audit and appeal resources can be found here.

Webinar: Meaningful Use, Audits, and Behavioral Health 

I'll be joining Mary Givens on September 12, 2013 at 2 PM EDT for a  

Meaningful Use Audit webinar designed specifically for the Behavioral Health Eligible Professional. Register for free here and send in questions ahead of time and we'll try and cover them.

 

http://www.hitechanswers.net/about/our-experts/emr-advocate/

 

 

 

 

The Appeal of a Failed EHR Incentive Audit

Interesting industry news update from EMR Advocate Jim Tate!

Appealing an Adverse EHR Incentive Audit

by Jim Tate
Twitter: @JimTate

The letter the hospital received said it all, “Based on our desk review of the supporting documentation furnished by the facility, we have determined that Hospital X has not met the meaningful use criteria………….Since your facility did not meet the meaningful use criteria, the EHR 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.”
If that doesn’t get your attention, nothing else will. I wouldn’t want to be the one that received the email and have to be the one to show it to the hospital CEO or Board. I would imagine the CFO also would not be too pleased. It sounds so final, “did not meet the meaningful use criteria” and “will receive a demand for  your total Medicare EHR incentive payment shortly”. I guess that is why it is call Final Determination. It sounds like a death sentence. But it doesn’t have to be.
I was contacted by the hospital the week after they received notification they had failed their EHR incentive audit and to expect a demand letter for a seven figure recoupment. They only failed one meaningful use measure, and it wasn’t the infamous Security Risk Analysis. If I had been on board earlier I could have perhaps helped with documentation and clarification that would have met the expectations of the auditor. It is hard to go back and reconstruct what happened during the 2011 attestation. Staff changes and memory fades. By the time I knew anything the audit was failed and they were behind the eight ball. Not a good place to be.
I was raised in the red clay of Georgia and my Aunt Betty was always saying, “Thank my lucky stars”. It was always “lucky stars” this and “luck stars” that. Well, I can tell you, when I heard about the appeals process for failed EHR Incentive audits the first thing I thought was, “Thank my luck stars”. We were told we were the first hospital that took a failed audit decision to the appeal level. That’s right, we were #001. We worked through the appeal process by providing additional clarifying documentation and participating in a number of conference calls. I felt we received a fair and transparent hearing. Last week the hospital received an email stating, “….we are reversing the adverse audit determination”. Now that is one email I bet everyone was glad to share. Thank their lucky stars. I hope you have a few of those lucky stars in your sky if you need them.
Having to go the appeal route is a bad sign. It means you have not met expectations and without some additional viewpoints or personnel a reversal is unlikely. For all providers, and especially for hospitals where so much is at stake, if the EHR incentive audit process is not going smoothly you simply must seek expert guidance on the process and requirements.

Jim Tate is founder of EMR Advocate and a nationally recognized expert on certified EHR technology, meaningful use and the EHR Incentive audit process. Contact him at jimtate@emradvocate.com.

http://myemail.constantcontact.com/News-Digest-for-July-9--2013--The-Appeal-of-a-Failed-EHR-Incentive-Audit.html?soid=1102564327964&aid=I0X4P4Xt73U

Guest Blogger - Jim Tate: EHR Incentives Drop Dead Dates

Several times a week I am asked the same question by providers and vendors. The question takes different twists and turns, but it all gets down to one core concern. To put it in the crassest terms, here it is. “What is the absolutely last drop dead date an eligible professional can meet the CMS EHR Incentive Program requirements and not leave any money on the table?” OK, now that the question is clear, let’s answer it once and for all.

For Eligible Professionals there are two CMS programs, Medicare and Medicaid, which incentivize EHR use. An EP must select one of the programs for participation, and is allowed to switch programs once. Let’s take a look at Medicaid first. 2016 is the “Last year to initiate participation in the Medicaid EHR Incentive Program” and 2021 is the “Last year to receive Medicaid EHR Incentive Payment.”

To continue reading this blog visit: http://www.hitechanswers.net/ehr-incentives-drop-dead-dates/

Jim Tate is a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and a partner in HITECH Answers. He is also author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1.

HITECH Answers - www.hitechanswers.net

To purchase Jim Tate's book "The Incentive Roadmap The Meaningful use of Certified Technology: Stage 1 visit:  http://www.hitechanswers.net/products-page/