So You Failed your Meaningful Use Incentive Audit?

By | May 29, 2014

It’s the end of the day and you slit open one of the last letters in your pile. A jolt of panic, you look away, hoping you didn’t read that right and you are just tired. Looking back at the letter held in your shaking hand you realize you read it right the first time.

“Based on our review of the supporting documentation furnished by the practice, we have determined that Provider Y has not met the meaningful use criteria………….Since this provider 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.”

You slump into your chair, and, head in hands, wonder what you will tell your partners and where you will possibly get the money to pay back incentive funds most of which are long gone. If there is a CFO, you know it won’t be long before you get a call from their office and asked to appear. Will you lose your job? You were counting on incentive funds for next year, had congratulated yourself on getting through the hurdles and obstacles that the attestation process had generated. It has been months. You were so certain you were free and clear. How could this happen?

It is important to remember you aren’t the only one who is dealing with a failed HIPAA Meaningful Use incentive audit. The question is what, if anything can you do about it? It depends on the reasons you failed and whether there is any room to address these reasons.

The Good

The good news is there is an appeals process for failed Meaningful Use audits. Remember, it’s always darkest before the dawn, it isn’t over until the fat lady sings and it’s now or never. Okay, so maybe the platitudes are a bit much, however, the message stands: You may have had difficulty with your pre-payment audit, as well as the attestation process, suffered through a post payment audit, only to find out after all that you failed, you’re going to want to give up – Don’t. There are steps you can take that might reverse this decision.

That being said, when you must go through the appeals process, it is not a good thing. It indicates you have not fulfilled MU Objectives completely based on CMS’s expectations. Unless you can supply additional interpretations from personnel not included in the post-payment audit, it is not likely you will be rewarded with a judgment reversal. Often, the appeals process is significantly more extensive than the original reporting process. This is because you may not know exactly why you failed so you will have to go through every bit of documentation and clarify all of it as fully as possible in the hopes that somewhere along the way you will have covered the problem and explained whatever seemed amiss. There’s no doubt the appeals process is extremely stressful. The time needed to locate the necessary documents, clarify everything you submitted and make numerous conference calls, is extensive and can severely interrupt work flow. Since this is your last chance for to be able to retain that year’s incentive money, you can’t let down your guard as you can in previous stages when you still have one or more corrective measures.

The Ugly

Perhaps you employed stop-gap-measures to shore up weak areas in the rush of an approaching pre-payment audit or attestation deadline. You might have truly intended to apply a more permanent solution as soon as the pressure lifted but then put it off due to day to day obligations. Often in such a situation, the days go by until one day the provider feels secure they will not be audited and pushed any additional improvements off until it is time to get ready for the next big hurdle. They haven’t looked at what is online in terms of when the audits will be completed and have decided they are they have dodged the proverbial bullet. Maybe you have operated this way due to all the responsibilities and pressure involved in your daily practice.

Think back to a time that pressure lifted and there was almost no stress involved in you work day . . . Can you do it? Of course not. That is because there is no such day. If you are lucky enough to get past earlier stages with stop gap measures in place that would have been enough reason for failing an earlier step and wait for calm before addressing it, you better pray you will never be audited. If you have received the fateful “You are about to be audited” letter, and are following the “wait until things are better” strategy, prepare yourself to return the entire amount of your incentive award. The audit is not going to go away and it is not likely you will be able to correct the weak points on such short notice.

The bottom line regarding stop-gap-measures is to not put of establishing better solutions in case of an audit. The likelihood of fixing things where corners were cut in the heat of an impending audit are slim. The lesson that should be learned from an audit that is failed for this reason is that it is best to do things right the first time. If it is absolutely necessary to apply temporary fixes to things to meet attestation deadlines, be sure to put in place permanent solutions that are easy to demonstrate as soon as possible. Never rely on the probability that you will fall in the 90% of those who are not audited. Also keep in mind that while many audits are random a large group of them are based on red flags raised within the attestation documentation.

Basics of a HIPAA Incentive Audit Decision Appeal

– Denials of Hardship Exemptions cannot be appealed

– The deadlines for electronically submitted documents are:

• Failed Audit Meaningful Use – 30 days from the date of the adverse audit determination letter
• Failed Reporting Meaningful Use – March 31st
• Eligibility – March 31st

– The date submitted will be the date that the request and supporting information is received by CMS

– Those who file a Failed Audit Meaningful Use appeal, may choose to extend EHR Incentive Payment. However, if the appeal is denied all repayment will be expected immediately to avoid further penalty

Updated Eligible Hospital and Eligible Professional audit appeal forms can be obtained by clicking on the links below:

Eligible Hospital Appeal Form

Eligible Professional Appeal Form

Make sure to fully review the appropriate form before beginning to gather documentation and additional information. It is a crucial step to enlist the aid of personnel who were not part of the initial audit process to obtain an unbiased evaluation of what needs to be addressed.

It is important to keep your fingers on the pulse of the compliance process subsequent to a failed audit. You must keep a careful eye and ear out for difficulties in the compliance process in order to sense any discomfort in the Meaningful Use compliance process. Should you get the sense that even after the measures you have taken following a failed audit that the process is still not running smoothly and appears to have glitches every so often, it is important to consult with and possibly hire a HIPAA expert who can help you determine any obstacles that are in the way of full compliance, and help you overcome them. The best thing you can do after a failed MU audit that could not be reversed on appeal is to take the experience and learn from it for the next year. This will help ensure that one MU Incentive Audit failure is the exception for you or your organization and not the rule.