Providers that fail a Meaningful Use audit have the right to appeal the determination. However, some providers who take this step are running into roadblocks that render the process confusing and in some cases downright unfair.
Jim Tate, president of Asheville, North Carolina-based EMR Advocate and an expert in Meaningful Use audits and appeals, recently published a blog post outlining some of the problems that providers have been facing. He shared his insights in an exclusive interview with FierceEMR.
FierceEMR: How does the Meaningful Use audit process differ from the audit appeals process?
Jim Tate: The audit process is very open and predictable. You're dealing with a human at Figliozzi and Company [the Center for Medicare & Medicaid Services' contractor conducting the audits]. There's a good communication effort. But the appeal level is not. It's a black box. For example, I file a lot of appeals. But CMS' contractor handling these appeals [Provider-Resources in Erie, Pennsylvania] can only accept one submission from an email address. You're supposed to get automatic notification of receipt of the appeal. I don't get them anymore.
FierceEMR: What are some of the problems that you and your clients have encountered?
Tate: Some appeals that were filed were lost during the 2013 federal government shut down and the providers were never notified. One hospital failed an audit for a technical thing that should have been reversed on appeal, but it was denied with no explanation.
The most outlandish was a practice that won its appeal in March. Two months later it received a letter from the same CMS official saying that the appeal was "reopened," that found its security risk analysis "insufficient" and then denied the appeal. That's egregious.
FierceEMR: What happens if a provider loses an appeal?
Tate: The final rule doesn't give providers an opportunity for review of an appeal. The only recourse is federal court. An eligible professional may not be able to do much about it--maybe they return $18,000. But a failed appeal for a hospital is a lot of money.
FierceEMR: Any idea what's gone wrong?
Tate: The contractor is a small firm that's understaffed. But CMS is really responsible for this process. I tried to get clarification from CMS. Elizabeth Holland at CMS is very nice but wouldn't speak with me or provide clarification.
This shouldn't happen. About 22 percent of eligible professionals fail the audits; 3 to 4 percent of hospital audits fail. We need an internal look at the whole appeals [process]. I just want a better process. We need an open process. I'm just tired of it.
Editor's Note: This interview has been condensed for clarity and content.