The Advantages and Disadvantages of Having a CEHRT in 2015

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1 Meaningful Use Audits Amy Fehn Law Offices of Fehn, Robichaud & Colagiovanni, PLLC HealthLaw Offices Troy, MI (248) Outline Background and Current Status of the Electronic Health Records (EHR) Incentive Programs Understanding the Meaningful Use Audit Program Proactive Steps to Take to Prepare for an Audit Practical Considerations Responding to an audit request Appeals process Questions 1

2 Background of the Meaningful Use Program Incentives for Meaningful Use of Certified Electronic Health Record Technology ( CEHRT ) payments began in 2011 will continue through 2016 Beginning this year penalties (sliding scale looks at year and # of providers who do not meet the criteria) Hardship Exceptions Infrastructure (area without sufficient internet access or insurmountable barriers) (e.g., lack of broadband) New Eligible Professional - 2 year limited exception Unforeseen Circumstances (e.g., vendor issues) Patient Interaction lack of face-to-face or telemedicine interaction; lack of follow-up need with patients Multiple Locations lack of control over availability of CEHRT for more than 50% of patient encounters Certain Specialists anesthesiology, radiology, pathology 2

3 Meaningful Use Stages Stages 1-3 In 2015, everyone is attesting to Modified Stage 2 (but can use exclusions and modifications which would have corresponded with previous Stage 1 and Stage 2) Meaningful Use Stages Stage 3 optional in 2017 and required in 2018 CMS called for additional 60 day comment period for Stage 3 3

4 Objectives and Measures Different for each stage Specification Sheets at Guidance/Legislation/EHRIncentivePrograms/index.html (google CMS EHR ) Certified Technology List of Certified Health IT: 4

5 Certified Technology In audit, will be asked for proof of vendor, product name and product version number Needs to have been appropriately certified for the year in which you are attesting For 2015, need to be certified to 2014 Edition Important Things to Know About Certified Technology Vendors provide the technology, but it is up to health professionals to use the technology as required. Sometimes additional set up or customization is necessary (e.g., patient reminders in Measure 12 of Stage 2) An EP should use clinically relevant information stored within the CEHRT to identify patients who should receive reminders 5

6 The Attestation Process A Word About False Claims Submission of a claim to any United States Agency + Knowing that claim is false = criminal false claim (including imprisonment and fines) Knowing presenting or causing to be presented a false or fraudulent claim for payment or approval = civil false claim (civil penalties including treble damages) Includes reckless disregard 6

7 The Audit Process Can be CMS or Contractors (Figliozzi & Company) States (Medicaid) Office of Inspector General (OIG) Can be prepayment or postpayment Can go back to 2011 The Audit Process Audit letters may be sent by Will include document request and deadline Examples of documents requested: Contract or Letter from CEHRT Reports Screenshots Zero denominator reports (for exclusions) Consider also submitting explanatory documents and affidavits 7

8 Potential Pitfalls Not having reports or screenprints appropriately dated Not having Security Risk Assessment document Not using the appropriate attestation period Not having evidence of CEHRT technology Being Proactive Save everything! Reports CMS guidance that you rely on Copy of the attestation Do a trial run prior to reporting period if possible to see if you can generate necessary reports/screenshots 8

9 Being Proactive (cont.) Do not wait until the last minute to do the attestation Review all educational information from vendor and CMS Utilize CMS Resources: Guidance/Legislation/EHRIncentivePrograms/index.html Join CMS list serve (Google CMS EHR Incentive Listserv) Guidance/Legislation/EHRIncentivePrograms/CMS_EHR_Listserv.html Being Proactive (cont.) Make sure that the Security Risk Assessment is reviewed, updated and documented every year!! 9

10 Security Risk Assessment Objective 1 = Conduct or review a security risk analysis Auditors will ask to see this document Example format = Standard/Impleme ntation Specification List the Standard and Implementation Specifications Observations Risks Additional Steps Taken or Proposed What you are doing to address? What are the risk (if any) with how you are doing things now? Additional steps that you will take and/or cost/benefit analysis. Resources for Security Risk Assessment Developed by ONC and OCR (electronic or paper-based) Developed by HIMSS 10

11 Appeals Process 30 days from date of audit determination submission preferred (can be faxed) Don t submit PHI (mask any patient information) No resubmission of documentation only additional documentation Submit appeal filing request form (check appropriate boxes) Electronic completion of form is preferred Questions? Amy Fehn HealthLaw Offices Troy, MI Direct (248) amy@healthlawoffices.com Schedule a Free Consultation: 11