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Latest Wave of MU Audits Delivers a Fresh Scare

Scott Mace, for HealthLeaders Media, October 29, 2013

This particular audit process dragged on. After four or five go-rounds with the auditor hired to do Texas-specific audits, "they finally just said, 'you just need to send us every single claim that you produced,' and we could de-identify it, but they wanted to know who the payer was and how much we were paid, and whether we were denied, for all payments, not just Medicaid.

"That was a surprise to us, and I challenged it all the way up to CMS, and I was told that that was a valid request. So be prepared for that."

Some providers, including McNutt, have even received phone calls as part of HHS's Office of Inspector General's effort to audit the auditors in each state.

At CHIME, I happened to mention this to former National Coordinator Farzad Mostashari, whose response was a shrug, signifying that this is the way things go with audits at times.

McNutt's co-presenter during the CHIME Webinar was Liz Johnson, vice president of applied clinical informatics at Tenet Healthcare, which has received nineteen audit notices so far. Tenet has the added headache of operating in 22 states, making its challenge and learning experience exponentially greater than Methodist's.

In some cases, the audit notice got to Johnson with only two days left to respond. "We did call and get a few extra days, but it is one of those things where you want to stay on top of it," she said.

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4 comments on "Latest Wave of MU Audits Delivers a Fresh Scare"


Jack Kolk (11/15/2013 at 9:04 AM)
It's more cut and dried than you think. As a company that has done 100's of risk assessments and been through the contesting of failed audits we know the process and what they are looking for. The fact that CHIMES members are still arguing over what is required is silly. The final guidance for a compliant risk assessment is at : http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf

Ellis Malovany (11/6/2013 at 9:29 AM)
This is precisely the reason why having the support of an accredited EMR company is critical. Providers have enough on their plate dealing with falling reimbursements and a confusing environment that has led many providers to throw up their hands and consider retirement or sidestepping into an alternative career. EMR companies need to stay on top of the changing targets and build value by proactively conveying information to their provider/clients. Unfortunately, in this "wild west" of EMR technology, only a handful of EMR companies understand how to manage and support.

Frank Poggio (10/30/2013 at 10:10 AM)
Scott, Cut an Dried?? I don't think so. At least not in the way you may think. The MU Attestation and vendor Certificaiton program and process was slapped together in a political rush. After completing dozens of Certifications for vendors I can attest that the process is far from black and white. Scripts get revised on a monthly basis, MU criteria is still getting redefined today. There was no audit process pre-tested and put in pace in advance, niether for vendors or providers. The appeals process is as clear as mud...and on and on. The only thing that will be Cut and Dried is: Providers will get the CUTS and vendors will be hung out to Dry when this is all over!