Meaningful Use Attestation Audits

  • fsgl

    fsgl - 2012-10-28

    There is a discrepancy between using "unique patient" and "encounters" in the denominators. In the Wiki article on "Descrip-
    tion AMC" (, encounters are used for the denominators while CMS' "Eligible Professional Meaningful Use Table of Contents Core and Menu Set Objectives" ( Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf) links to each of the individual measures define
    "unique patient" thus "If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term ‘‘unique patient’’ relate to what is contained in the patient’s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period."

    This is problematic even without the news about the Figliozzi & Co. contract.

    This is the memo from Hooper, Lundy & Bookman, P.C.:
                                                   CMS BEGINS EHR INCENTIVE PROGRAM AUDITS

    As of the end of May 2012, over 110,000 eligible professionals and over 2,400 eligible hospitals have attested to meaningful use of electronic health records (“EHR”) and have received incentive payments of $5.7 billion dollars by either the Medicare or Medicaid EHR Incentive Program. Any provider that has attested to meaningful use to receive an EHR incentive payment may be subject to an audit. On April 16, 2012, CMS awarded a contract to Figliozzi & Company to perform audits of Medicare providers and dual-eligible Medicare and Medicaid providers that have attested to meaningful use to receive an EHR incentive payment, and Figliozzi & Company has recently started to conduct these audits.

    If a provider is being selected for an audit, it will receive a letter from Figliozzi & Company with the CMS logo on the
    letterhead. Some providers have already received audit letters, and more are sure to follow. Peter Figliozzi, of Figliozzi & Company, has been auditing healthcare facilities to determine compliance with Medicare regulations for over two decades. At Hooper, Lundy & Bookman, we have extensive experience representing clients facing audits by Mr. Figliozzi. In particular, our attorneys represented a hospital system in the largest hospital payments investigation in U.S. history for over four years where Mr. Figliozzi acted as the lead auditor and audit expert for the plaintiffs. Ultimately, this firm achieved a largely successful result for the client on such audits. CMS provides an overview of the audit process at Audits are
    conducted to both validate that the provider accurately attested and submitted Clinical Quality Measures (CQMs), and to verify that the incentive payment received was accurate. If, based on the audit, Figliozzi & Company determines that the provider was not eligible for the EHR payments received, those payments will be recouped.

    To prepare for a potential audit, CMS advises that each provider save documentation supporting its attestation, CQMs, and payment calculations. Providers should retain all relevant supporting documentation for at least six years post-attestation.
    Documentation to support payment calculations (such as cost report data) should follow the current documentation process. According to early reports, the audit letters from Figliozzi and Company request four categories of information: (1) a copy of the certification for the technology system used; (2) documentation to support the method chosen to report emergency department admissions; (3) documentation supporting the attestation module responses related to the core set objectives and measures; and (4) documentation supporting the attestation module responses related to the menu set of
    objectives and measures. The audit letters to date only provide two weeks to respond. 

    If a provider believes that the audit decision is in error, it can appeal that decision through an EHR Incentive Program administrative appeals process. The Office of Clinical Standards and Quality (“OCSQ”), an office within CMS, provides a two-level appeal process comprised of an informal review and a request for reconsideration. Generally, providers can file an Eligibility Appeal, a Meaningful Use Appeal, or an Incentive Payment Appeal, although Incentive Payment Appeals for hospitals are referred to the Provider Reimbursement Review Board. All of these types of appeals must be filed quickly. For example, Meaningful Use Appeals must be filed no later than 30 days after the date of the demand letter for recoupment, and Incentive Payment Appeals must be filed no later than 60 days after a determination that the incentive payment amount was incorrect.

  • fsgl

    fsgl - 2012-11-01

    Dear Mr. Miller,

    Thank you for the clarification.  Initially I interpreted "Category Counted: patients, Denominator criteria: encounter" as the number of patient visits, not as "unique patient" according to my second link and pages 5 and 6 of your second link.  I manually counted the number of unique patients that I had seen since the implementation of OpenEMR and all the measures
    that require unique patients in the denominator were correctly populated.  Physicians tend to get a little edgy when they get
    news that the feds may audit them.

    If I may make a suggestion.  The calculation for the CPOE measure works fine for my colleagues in Internal Medicine and
    Family Practice, but for those of us in the specialties and with small practices, it does not work quite as well. It would be very
    helpful to have box for drugs prescribed by the PMD and one for our office with 2 calculations for the CPOE measures.  CMS will permit such calculations as noted in {FAQ 164} :"For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP) who orders medications
    infrequently calculate the measure for the “computerized provider order entry (CPOE)” objective if the EP sees patients whose medications are maintained in the medication list by the EP but were not ordered or prescribed by the EP?
    The CPOE measure is structured to minimize reporting burden. However, if all of the following conditions are met it can also create a unique situation that could prevent an EP from successfully demonstrating meaningful use. An EP who: 1)  prescribes  more  than  100  medications  during  the  EHR  reporting  period; 2)  maintains  medication  lists that include  medications  that they  did  not order;  and 3)  orders  medications  for  less   than  30  percent of patients  with  a  medication  in   their medication list during the EHR reporting period. In these circumstances, an EP may be both unable to meet this measure and unable to qualify for the exclusion. In the unique situation where all three criteria listed above apply, an EPs may limit their denominator to only those patients for whom the EP has previously ordered medication, if they so choose. EPs who do not meet the three criteria listed above must still base their calculation on the number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period regardless of who ordered the medication or medications in the patient’s medication list.  Date Updated: 5/17/2011"

    Non sequitur: I have started a thread in the American Academy of Ophthalmology Community Forum about OpenEMR.  The AAO is the professional association of US Ophthalmologists.  I hope the thread will generate interest and support for the project.  I had sent an email entitled "Cookies (the kind you eat)" & the offer is still good.

    Best regards,

  • fsgl

    fsgl - 2012-11-01

    Oops… the attempt at elegance failed, best stick to a simple link next time and leave the named links to the pros.

  • Brady Miller

    Brady Miller - 2012-11-04

    Hi fsgl,

    Regarding your mod to the CPOE measure, guessing this is possible with some code modifications. The rule calculation change would be straightforward, but the more difficult thing I think to do would be to add the pieces to allow separation of meds between inside/outside docs (my thoughts would be a prescriber field when entering in a med which could choose oneself or an outside physician; this field could then be used by the rule calculation).

    I am still planning to collect on those cookies at some point :)


  • fsgl

    fsgl - 2012-11-05

    Great if we can put our own meds in the prescription box.

    Edible cookies will need a destination when you are ready.


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