Tips for Passing an EHR Incentive Audit

By | April 1, 2014

When CMS first announced the availability of incentive funds for eligible providers who adopted an Electronic Health Record and were not only willing to comply with all HIPAA rules and regulations as defined by HITECH and the final Omnibus rule but also with the Meaningful Use Criteria, many providers considered not applying for money. This was due to an initial concern over the ability to meet the deadlines and the belief that the potential fines and relinquishment of future incentive money would constitute a hardship should they not be capable of demonstrating Meaningful Use compliance. Most of these Eligible Providers subsequently decided to apply and many received the funds. That’s the good news.

The bad news is it is now time to provide documentation of compliance with Meaningful Use Stage 1 criteria and many are struggling despite the extended deadline. As they say, forewarned is forearmed, so be aware that it is crucial to triple check everything you submit and to make certain that all key personnel know how to demonstrate compliance appropriate to their areas during an audit since failing either of these steps minimally lead to additional time and effort in order to correct whatever mistakes were made or maximally, will not be able to be corrected due to the auditors having established the failure was due to incomplete compliance with Meaningful Use Stage 1 objectives. Keep in mind that it doesn’t matter whether you are fully compliant or not if it is concluded that you failed to demonstrate compliance adequately on your report or during an audit.

That being said, there are a number of things you can do should you receive a dreaded audit letter that will improve your chances of passing the audit. The following are a few tips for handling an audit properly from the time you first open the notice letter until the auditors walk out the door.

Tips for Passing an EHR Incentive Audit

1) Don’t get angry at the auditors. While this seems self-evident, sometimes it can be difficult for busy professionals to remember that the auditors aren’t attempting to trap them into losing money. The auditors are human and could react to a loss of temper by refusing to let you take advantage of any allowed leniencies or simply view you as guilty of non-compliance until you prove your innocence. This is not the position you want to find yourself in. Instead of having to dig yourself out of a hole, a fate other key personnel will share, you can act in a manner that will let you start on firm ground so you can immediately begin climbing higher in the esteem of the auditors. If the most you can hope for is to possibly reach level ground where you should have started off, you will find passing the audit difficult from the get go. In the rare instance an auditor does seem to be overly critical or negative (don’t forget auditors can have bad days also), you can disarm them by meeting their surliness with positivity and a sunny disposition.

2) Make sure to respond promptly. There is a long list of documents you will be asked to supply so start assembling them as soon as you receive the letter. Notify all staff members of the upcoming audit whether they will need to be part of the process or not. Get everyone involved in helping to collect documents or provide them with a task, even if only making copies of documents in order to create a team feeling. Not only will this impress the auditors, it will provide all those responsible for demonstrating compliance functions during the audit with a sense of support and camaraderie.

3) Aside from supplying the required documentation, don’t communicate with the auditors prior to the audit. Sometimes practitioners believe that an informal conversation prior to the audit covers something that requires a document. Believing that compliance with certain aspects of Meaningful Use objectives has already been demonstrated during a conversion with auditors, you may fail to provide the necessary paperwork to substantiate compliance. This alone can result in failing an audit.

4) If the letter asks for a document, provide a document. Make sure the documentation you provide is more than a statement that asserts compliance. When verification is required, stating that you have complied with A, B, and C is not sufficient. Review what records are accepted as confirmation of compliance before submitting your reply.

5) Check all documents previously submitted against those you will be submitting in response to the audit letter to avoid discrepancies. The documents you submitted prior to receiving the funds should match what you actually did to establish and maintain compliance. The documents submitted for the audit should match those submitted when attesting to Meaningful Use Stage 1 compliance and both should match what was provided when applying for the funds.

6) Be aware of the three types of documents that will be requested and make sure they are available, complete and up to date. Documents required include:

a. Confirmation that you are using a certified HR system
b. Records verifying the accuracy of your quality measure, core, and menu objective data
c. Documentation showing that a security risk assessment was undertaken along with an appropriate remediation plan

7) Make sure that you retain all the data used for the report submitted when attesting to compliance for Meaningful Use Stage 1. Data should be clear and require little or no interpretation for auditors to fully understand. Complex is not necessarily better when it comes to the numbers. Should auditors leave your site without being able to confirm the sources for the statistics you reported when attesting, you will fail not only the audit but the attestation stage as well.