AUDITS, OPPORTUNITIES, & ROADMAPS
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1 CPAs & ADVISORS experience ideas // Mike Orr, Director Travis Skinner, Senior Managing Consultant AUDITS, OPPORTUNITIES, & ROADMAPS
2 TODAYS AGENDA EHR Tentative Settlement Letters 2014 Criteria for Stages 1 & 2 Flexibility Final Rule PPS & CAH Penalties HITECH Payment Audits EHR Meaningful Use Audits EHR Roadmaps
3 EHR TENTATIVE SETTLEMENTS
4
5 EHR TENTATIVE SETTLEMENTS Letters appear not credible Usually letters do not contain dates, program year, or reasons for the payback; only that it is related to an EHR Payback. Affecting facilities that have a cost report received/accepted by CMS on or after 10/01/2013
6 EHR TENTATIVE SETTLEMENTS When there is a difference in interim payment and calculated settlements: Majority of settlements have resulted in paybacks to the program The jurisdictional MAC conducts the calculation and review (can be done incorrectly.) Any difference is due back to company immediately.
7 EHR TENTATIVE SETTLEMENTS When an additional payment is due to the facility: If comparison between interim payment and calculated settlement payment is a receivable to the facility, it has to be more than a 15% difference between the two payments before CMS issues a payment to the facility. If not more than 15%, it is considered immaterial and will be settled at the HITECH Settlement Audit.
8 2014 CRITERIA FOR STAGES 1 & 2 All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period. For Medicare providers, this 3-month reporting period is fixed to the quarter for both EPs & EHs. For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3- month reporting period is not fixed. CMS is permitting this one-time three-month reporting period so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.
9 2014 CRITERIA & STAGE 1 Differences between 2013 Criteria and 2014 Criteria for Stage 1: Core Measures Patient Portal Removed certain Objectives
10 2014 CRITERIA FOR STAGE 1 Patient Portal Objectives Removed Electronic Copy of Health Information Electronic Copy of Discharge Instructions Clinical Quality Measures Still required to report in order to achieve MU
11 2014 CRITERIA FOR STAGE 2 Changes to Core & Menu Measures Threshold Increases Health Information Exchange Patient Engagement Electronic Clinical Quality Measures
12 2014 CRITERIA FOR STAGE Criteria from Stage 1 to Stage 2 Core Objectives from 11 to 12 Combined Stage 1 Menu Measures in with Core Measures Including all three (3) HL7 interface public use measures in with the Core Measures Patient Portal increases requirements
13 FLEXIBILITY FINAL RULE 2014 Regulation BEFORE Flexibility Final Rule 90 days tied to a quarter regardless of Stage of MU Criteria for ALL Stages of MU Facilities attesting to Stage 1 MU must meet the 2014 Criteria Stage 1 MU Facilities with 2 or more program years of attestation to Stage 1 MU must attest to Stage 2
14 1 st Year Stage of Meaningful Use TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD
15 NPRM FROM CMS & ONC
16 FLEXIBILITY FINAL RULE 2014 Participation Options Under this proposal, valid only for the 2014 reporting year, providers would be able to use 2011 Edition CEHRT for either Stage 1 or Stage 2, would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and use the 2013 definition CQMs. Providers currently working on Stage 1 in 2014 would be able to demonstrate: Stage 1 (2013 Definition) using 2011 Edition CEHRT, or a combination of 2011 and 2014 Edition CEHRT; or Stage 1 (2014+ Definition) using 2014 Edition CEHRT. Providers currently working on Stage 2 in 2014 would be able to demonstrate: Stage 1 (2013 Definition) using 2011 Edition CEHRT, or a combination of 2011 and 2014 Edition CEHRT; Stage 1 (2014+ Definition) using 2014 Edition CEHRT; or Stage 2 (2014+ Definition) using 2014 Edition CEHRT.
17
18 FLEXIBILITY FINAL RULE What does this mean? EHR program could be extended EHR MU Audits become more complicated What could 2017 bring? Harsher penalties? Or additional funding?
19 PPS & CAH PENALTIES Differences in PPS & CAH penalties in both type and timing. Hardship exemptions for both PPS & CAH. When and what effects will penalties have on PPS & CAH?
20 PPS PENALTIES
21 PPS PENALTIES
22 PPS PENALTIES
23 CAH PENALTIES
24 CAH PENALTIES
25 PPS & CAH PENALTIES 2014 Hardship Exemptions Customized so that it doesn t take an Act of God to qualify for exemption Assists both PPS & CAH in avoiding payment adjustments from not being able to complying with 2014 regulations.
26 HITECH PAYMENT AUDITS (MAC) For every Medicare EHR incentive payment, every facility that receives an EHR incentive payment will have one of three audits on their cost report: Desk review In-House Audit On-Site Audit
27 HITECH PAYMENT AUDITS (MAC) Positive Adjustment Opportunities Part C Days Total Days Charity Care Presumptive Charity Care Policy Review
28 HITECH PAYMENT AUDITS (MAC) CMS/MAC tried to disallow all of Charity Care Charges Treated as bad debt Big policy issues We WON!
29 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Worked on program years 2011 and 2012 Program year 2013 first round already in process Another round near October 2014 Still auditing a minimum of 5% of the nations Meaningful Users
30 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) A CPA s perspective brings better understanding of what Figliozzi auditors are looking for EMR Software is certified so there shouldn t be any IT issues Security Risk Analysis
31 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Having a documentation review at the beginning or during the middle is better than after receiving notification of failure. ALL or NOTHING penalty Including Medicare & Medicaid incentive payments
32 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Facilities can fail for the craziest problems The horror stories! Mitigation Strategies Hospitals have gone through MU Audits in consecutive years. If facility fails per Figliozzi, then the facilities previous program year (if have one) and the next program year will/could be audited!
33 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Working with Figliozzi is easier than with CMS if facility fails. Can appeal Figliozzi failure with CMS One Bite at the Apple Submit only NEW evidence
34 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) The Lost in Translation What are they looking for? Why are they looking for it? Why does this documentation not work?
35 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) The following is reviewed during a MU Audit: Support for System Method Chosen for Statistics Core Measures Security Risk Analysis Menu Measures
36 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Risks for unaudited facilities: OIG threatening to do their own audits CMS can go back to review other program years Unidentified documentation issues What can you can do to mitigate these risks?
37 EHR MEANINGFUL USE AUDITS (FIGLIOZZI) With Flexibility Final Rule approved: 2014 MU Audits will be complex Any of the following stages of MU & Criteria can be audited: Stage 1 ( Criteria) Stage 1 (2014 Criteria) Stage 2 (2014 Criteria)
38 EHR ROADMAP So much bad information Documenting future events Customized specific for your facility Protects against losing Black Box knowledge
39 EHR ROADMAP What could be included on a ROADMAP? Timelines Guidance Penalties Confidence Payments Outlook Stages of MU Deadlines Reporting Periods Attestations
40 KEY TAKE AWAYS FROM THIS PRESENTATION Patient Portal Requirement Help from the new Flexibility Final Rule MU Audit penalty is very REAL and the key is your documentation Every participant that receives an interim payment will experience a HITECH audit Understanding the Road that lays ahead of your facility 40 // experience ideas
41 THANK YOU THANK FOR YOU MORE INFORMATION // visit bkd.com or contact: Mike Orr // Director // (ext ) Travis Skinner // Senior Managing Consultant // (ext )
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