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CMS conducting pre-payment audits before releasing 2013 EHR Incentive Program bonuses


If you thought demonstrating meaningful use annually to receive electronic health record (EHR) incentive payments was enough, think again.

The Centers for Medicare and Medicaid Services (CMS) is performing pre-payment audits —in addition to the post-payment meaningful use audits that started last summer—before mailing out some bonus checks. CMS says the audits affect a random sampling of 5% to 10% of incentive applications.

According to CMS, the pre-payment audits began with attestations submitted during and after January 2013, in addition to pre-payment edit checks already built in to the EHR Incentive Programs’ systems. The audits may target suspicious data, says CMS, and providers selected for audits will have to provide data to back their attestation or validate their submitted data before CMS will release their bonus payment.

Providers selected for audits will receive a letter from CMS’ contracted CPA firm, Figliozzi & Co. An initial review will follow, using data provided to CMS in a response to the audit notice from the provider. On-site reviews may follow in some cases and could include a demonstration of the provider’s EHR system. Any providers who are found to be ineligible for their bonus may initiate an appeals process, CMS says.

CMS says that out of 527,300 eligible professionals, 372,600 have registered for the EHR Incentive Program to date, with 17,532 registrations so far this year. Medicare-eligible physicians made up 11,714 of those registrations, and Medicaid-eligible physicians account for another 2,688. So far this year, no Medicare-eligible physicians have been paid their incentive payments, and 45 Medicaid-eligible physicians have been paid nearly $900,000 in bonuses. More than $12 million has been awarded so far for the 2013 program year to all eligible professionals, according to CMS.

 

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