Meaningful Use audits: What providers can expect

By Marla Durben Hirsch

With the Centers for Medicare & Medicaid Services doling out billions of dollars in Meaningful Use incentive payments, it is no surprise that providers are increasingly at risk of being audited to see if they actually were entitled to the money.  

CMS has stated that it intends to audit about 5 percent of all providers to ensure that they are meaningfully using their electronic health records, but that number is likely higher. About 10 to 15 percent of eligible hospitals attesting to Meaningful Use can expect to be audited; for eligible professionals the number may be closer to 20 percent, according to David Zavala, senior manager with consulting firm Protiviti in Dallas.  Even if only 5 percent of providers are audited, that's still 20,000 providers, according to attorney Brian Flood, with Husch Blackwell in Austin, Texas.

And the stakes of being audited are high: A provider that fails just one element of a Meaningful Use audit not only must return the entire incentive payment for that year, but also is automatically scheduled for another audit of another participating year, according to Flood.

"They keep going until you pass or they have it all back," he warns.

Moreover, CMS is under pressure to conduct these audits vigilantly. The Government Accountability Office (GAO) has warned that the Meaningful Use program may be at greater risk than other programs of making inappropriate payments because it's relatively new and so complex. The Office of Inspector General (OIG) has already chastised CMS for not auditing the program adequately.

So how can providers reduce the risk that they'll be subject to a Meaningful Use audit? And what steps should they take to improve their chances of passing one? Read FierceEMR's latest special report to learn more.

Meaningful Use audits: What providers can expect