AMA: Auditors Should Pay For Their Mistakes

The American Medical Association (AMA) is telling lawmakers and regulators that Recovery Audit Contractors (RACs) making incorrect accusations should be penalized. The RAC system, which rewards the government’s contracted investigators based on the volume of improper payments they find, has long been criticized by healthcare providers. The AMA believes there are not enough disincentives for auditors who make false accusations without merit. The AMA is also asking CMS to pay providers interest when they successfully appeal a finding. As of now, there is a two-year RAC appeal backlog which federal regulators are working through. The AMA believes that without any government action, RACs will “continue to operate under their current financial incentives and resist changes that would improve audit accuracy, reduce the number of appeals, and mitigate the burden on physicians.

Click here to read the AMA letter to CMS.

Click here to read more.


Check Out Our New Look!

HMS Healthcare Management Solutions is pleased to announce the launch of our new website. Our site has been redesigned with a fresh new look and updated information on all the products and services HMS has to offer.

Learn more about our billing and collections, consulting services, social media strategies and how HMS can help prepare providers for audits and appeals.  Visitors also have access to our resource center for the latest and archived editions of our newsletters as well as case studies highlighting HMS success stories. Links to the HMS blog and our social media sites are conveniently located at the top of our homepage for easy access to HMS on Facebook, Twitter and more!

Visit today to see all of the changes we’ve made!

Meaningful Use Monday: Preparing For An Audit

Any provider attesting to receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program potentially can be subject to an audit. Here’s what you need to know to make sure you’re prepared:

  • Save the electronic or paper documentation that supports your attestation.
  • Save the documentation that supports the values you entered in the Attestation Module for Clinical Quality Measures (CQMs).
  • Hospitals should also maintain documentation that supports their payment calculations.

If you are selected for an audit, the documentation will be used to validate that the provider accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate. If a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped. The Centers for Medicare & Medicaid Services (CMS) has an appeals process for eligible professionals, eligible hospitals, and critical access hospitals that participate in the Medicare EHR Incentive Program.

Click here to read more.

Meaningful Use Monday: Audits Are On Their Way

The Office of the Inspector General (OIG) will undertake a review of American Recovery and Reinvestment Act (ARRA) which will include probes into the EHR stimulus program to ensure that people attested to meaningful use properly.

In its latest plan, OIG states it will look at incentive payments made by the Centers for Medicare & Medicaid Services CMS made beginning in 2011 to identify payments to providers that should not have received incentive payments  – those that did not meet the meaningful use criteria. The OIG will also assess CMS’s plans to oversee incentive payments for the duration of the program and actions taken to remedy erroneous incentive payments.

If you’re part of a meaningful use audit or have information on what’s involved, please let us know. HMS Healthcare Management Solutions would love to learn from those who have firsthand experience with the process.

HMS Participates In DSS Audit Education Program

Earlier today, Healthcare Management Solutions (HMS) Director of Consulting, Cheryl Leslie and HMS Director of Home Care & Hospice Services, Kim Skehan participated in a training and education program on audits performed by the Connecticut Department of Social Services (DSS).

The program, Your DSS Audit Is Coming – Are You Ready?, was held at Workers’ Compensation Trust in Wallingford and included presentations by attorneys John M. Letizia and Phyllis M. Pari from Letizia, Ambrose & Falls and Marcum LLP Director of Advisory Services, Gary Richter. A dramatic increase in the number of Medicaid audits conducted by the Connecticut Department of Social Services resulting in significant audit penalties prompted the discussion.

Click here to read more.

Meaningful Use Monday: Preparing For Provider Audits

The end of the first 90-day period for the 2012 Meaningful Use authentication drew to a close in March. Before you sit back and wait for your check, make sure that you assemble all the documentation to support the information you provided to the Centers for Medicare & Medicaid Services (CMS). Provider audits will be performed and those without back up might be in jeopardy of forfeiting their incentive payments.

Here are some tips on what to save to create a comprehensive documentation portfolio:

  • EHR Automated Measure Calculation Report
  • Clinical Quality Measures Report
  • Clinical Decision Support Rule
  • Successful Data Exchange Test
  • Security Risk Analysis
  • Ability to Submit Immunization Data / Syndromic Surveillance Data
  • The Patient List

Documentation can be in paper or electronic format and should be retained for 6 years.

Please note: CMS does not specify necessary documentation – the above is simply an outline.