EMR and Meaningful Use. How to Prepare for Audits and Avoid Penalties

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1 EMR and Meaningful Use How to Prepare for Audits and Avoid Penalties

2 Payment Adjustments for Eligible Professionals who are not Users of Certified Electronic Health Records (EHR) Technology

3 Off-Label Use Disclosure(s) I do not intend to discuss an off-label use of a product during this activity.

4 Financial Disclosure(s) I have not had any relevant financial relations during the past 12 months to disclose.

5 Overview As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress mandated payment adjustments to be applied to Medicare eligible professionals who are not Meaningful Users of Certified Electronic Health Record Technology. These payment adjustments will be applied beginning on January 1, 2015 The payment adjustment will be applied to the Medicare physician fee schedule (PFS) amount for covered professional services furnished by the professional during the year.

6 What do the Payment Adjustments Look Like? If you attested in 2011, 2012 or 2013 and you miss attestation in: you will receive a: % cut in % cut in % cut in % cut in % cut in and beyond 3-5% cut If you have never attested previously and you miss attestation in: you will receive a: 2013 no penalty % cut in 2015 & 2% in 2016 Eligible Professionals receive the payment adjustment amount that is tied to the year that they did not demonstrate MU Ex. The professional who is eligible for a payment adjustment in 2018 will receive a 4% PFS reduction regardless if it is their first or fourth year of not demonstrating MU and beyond refer to above chart

7 Incentive & Payment Adjustment Summary This table demonstrates the potential adjustments over a combination of Medicare Programs including the EHR Incentive Program, PQRS (Physician Quality Reporting System) and the Value Modifier Program. *Potential loss of 7-9 % across the 3 programs

8 The 5 Man Group This following is a true story based on a 5 provider practice and what can happen if you do not have the right person assisting with your MU Attestations.

9 $111,680 Incentives that were returned to CMS from 5 providers In addition to returning the incentive funds, the providers will now be subject to 1% in 2015, 2% in 2016 and will increase by a percent every year with a maximum of 5%. Per a CMS report, the average oncologist had over $325,000 in Medicare reimbursements in For a practice of 5 providers, that would be a loss of $16,250 for the year. Of course, this amount can vary greatly depending on the number of Medicare patients that are seen by the provider.

10 Ways to Prevent the Payment Adjustments Demonstrate Meaningful Use of Certified Electronic Health Record (EHR) Technology under the Medicaid Incentive Program Apply for a Hardship Exception these Hardship Exceptions are only granted under very specific circumstances and only if CMS determines that the providers have demonstrated that those circumstances pose a significant barrier to their achieving Meaningful Use Categories that fall under the Hardship Exceptions in 2014: Infrastructure New Eligible Professionals Unforeseen Circumstances Patient Interaction

11 The Audits are coming! The Audits are coming!

12 Things you should know about audits: For every year of MU Attestation, you can be selected for an audit up to 6 years afterwards There are Pre-payment and Postpayment audits Your entire payment is at stake- it s All or None. There are no penalties on this money You can be selected for an audit more than once The Eligible Provider is ultimately responsible for all information submitted for the MU Attestationyour office manager will not have to return the funds; you will

13 Attest for Meaningful Use with the assumption you will be audited later! 80% of your patients records MUST be maintained in your EHR to qualify MU data is collected on ALL of your patients, not just your Medicare patients Designate a point person in your office to oversee all of the documentation and communication with you as the Eligible Provider Keep all documentation in a Book of Evidence as well as digital copies A Security Risk Analysis IS REQUIRED to attest to Meaningful Use. This is not the responsibility of your EHR/EMR Vendor

14 What is a Security Risk Analysis? A Security Risk Analysis is a comprehensive look into your practice to assess how well you are protecting your patients health information (PHI) It encompasses Technical Safeguards, Physical Safeguards, and Administrative Safeguards It must be reviewed every year (within the Reporting Period for MU)

15 Security Risk Example:

16 What to do if you receive notice from Figliozzi that you are being audited? Review the documentation to know what you are being asked to supply Enlist your EHR Vendor for support with documentation- EHR Verification Letter and a copy of your purchase agreement of the software Only provide what is being requested- nothing more Don t miss the deadline given by the auditor; ask for an extension if necessary Keep in mind that the first attempt to reach you will be through the address that was used when Registering for the EHR Incentive Program. If this is not monitored regularly, you may miss the deadline!

17 What if I fail the Audit? Appeal Process If you believe that there is a legitimate reason to do so, you can file an Appeal Appeals must be filed within 30 days from the date of the adverse audit determination letter Get outside assistance from a reliable source Failing an audit does not preclude you from future, prior, or subsequent year audits Guidance/Legislation/EHRIncentiveProgra ms/downloads/appeal_ep_filingrequest-.pdf

18 Recoupment of Incentives Even though you may go through the process of filing an Appeal for a failed audit, you will receive a Demand letter to return your Incentive monies.

19 A few things to keep in mind Get qualified help Don t expect your Meaningful Use Attestation, Audit or Appeal to be handled by your Office Administrator alone Stay involved in the Process- it s your money Take your documentation with you if you leave a practice and move to another