DC Report: CMS Launches Meaningful Use Audits

July 31, 2012
Providers who have attested to Meaningful Use can soon expect a visit by CMS auditors, the agency confirmed this week. Meanwhile, Agency for Healthcare Research and Quality (AHRQ) late last Friday issued a Request for Information regarding health IT-enabled quality measures.

CMS Launches Meaningful Use Audits Providers who have attested to Meaningful Use can soon expect a visit by CMS auditors, the agency confirmed this week.  Although CMS and its audit contractor Figliozzi & Company have been mum on details, CMS has posted audit guidelinesonline.  According to the guidelines, providers “should retain ALL relevant supporting documentation (in either paper or electronic format used in the completion of the Attestation Module responses); documentation to support the attestation should be retained for six years post-attestation and documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes.”  It goes on to emphasize that eligible professionals and hospitals save the documentation to support your Clinical Quality Measures (CQMs) because the audit will look to validate that the provider accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate.

Gov Requests Info on HIT-Enabled Quality MeasurementAgency for Healthcare Research and Quality (AHRQ) late last Friday issued a Request for Information regarding health IT-enabled quality measures.  The AHRQ RFI seeks information regarding current successful strategies and/or remaining challenges encountered regarding the development of quality measurement enabled by health IT.  The RFI outlines three categories of challenges, including (1) underdeveloped or unavailable infrastructure (e.g. whether the measure set should be extensive or parsimonious); (2) incompleteness of the measure set (e.g. developing measures that matter to consumers, how to measure value) and (3) technology challenges (e.g. how might unstructured data be captured in the EHR to be used for measurement, if and how to integrate patient-generated and clinician-generated data).  The agency is “seeking information on the building blocks of health IT-enabled quality measurement in terms of perspectives, practicalities and priorities.”  The RFI seeks input on 15 questions, most of which ask for specific examples. 

Government Accountability Office Takes Hard Look at First Year of Medicare Incentive Payments

According to a new report out from the Government Accountability Office (GAO) 761 hospitals and 56,585 eligible professionals were paid a total of $2.3 billion in Medicare EHR incentive payments in 2011.  These totals represent 16 percent of eligible hospitals and 9 percent of eligible professionals – which align with CMS’s estimates when starting the program.  Some other highlights on the EH side includes:

  • Hospital payments ranged from $22,300 to $4.4 million, with the median payment amount of $1.7 million.
  • About 61 percent of hospitals accounted for about 80 percent of the total amount of incentive payments awarded to hospitals;
  • The largest proportion (44 percent) were located in the South, and the lowest proportion (12 percent) were located in the Northeast;
  • About two-thirds (67 percent) were in urban areas;
  • More than four-fifths (86 percent) were acute care hospitals; and
  • Almost half (46 percent) were in the top third of hospitals in terms of number of beds.

The report went on to find that hospitals with certain characteristics were more likely to have been awarded a Medicare EHR incentive payment for 2011.  For example, acute care hospitals were more than 2 times more likely than critical access hospitals to have been awarded an incentive payment.  Hospitals in the top third in terms of numbers of beds were 2.4 times more likely than hospitals in the bottom third to have been awarded an incentive payment.  Further, nonprofit and for-profit hospitals were 1.1 and 1.5 times more likely than government-owned hospitals, respectively, to have been awarded an incentive payment.

Some readers will recall that CMS compiles monthly and quarterly reports on the Medicare & Medicaid EHR Incentive Payments program, but this is the first in-depth report to be undertaken by government accountants and auditors.

Docs Urge Lawmakers to Extend EHR Incentives to Rural Health Clinics, ASCs During a legislative hearing this week on replacing the existing Medicare payment system, physicians urged lawmakers to extend EHR Incentive Payments to rural health clinics and ambulatory surgical centers.  The hearing was held by the House Ways & Means Health Subcommittee and included witnesses from the American Gastroenterological Association, the American College of Physician Executives and individual physician groups.  According to Subcommittee Chairman Wally Herger (R-Calif.) Congress must do more than simply repeal the sustainable growth rate formula, it also has to determine how to improve the current system.  The panel of witnesses agreed that extending Meaningful Use payments to other quadrants of the provider community would be a good way to start – especially in a new payment system where doctors are asked to do more and get better results while controlling costs in a post-sustainable growth rate setting.

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