Case Studies

Do You Really Know Meaningful Use?

You would suspect that physicians and staff are begging for help due to the complexities and detailed steps associated with Meaningful Use. But are they? Do people know enough about Meaningful Use to know that they need help? More often than not, the answer is no, and this is leading to money being taken right out of the pockets of healthcare organizations across the country.

Background on Meaningful Use Incentives and Penalties

With the development of ARRA and The HITECH Act in 2009, many providers and administrators didn’t put much weight into Meaningful Use being a program that was going to stick around very long. But, here we are 7 years after program development, and providers and clinicians are scrambling to either get whatever incentive is left on the table for them (if any), or attempting to avoid any impending penalty. If you were a Medicare provider that jumped on the MU bandwagon in 2010 as an early adopter, you were eligible for $44,000 in incentives. Medicaid providers were eligible for up to $63,000. At this point, the potential incentives have decreased, but providers are still at risk of facing penalties on every one of their Medicare claims if they aren’t compliant.

Along with these known incentives/penalties, there is a lesser known risk that organizations need to be aware of that could force them to pay back much of the incentive money that they have collected to-date. This risk refers to the audits that CMS is randomly conducting on healthcare organizations that have received incentive payments since the inception of the program. If the auditors determine that the organization did not attest with full compliance, or don’t have the detailed records that they need to prove compliance, they will be expected to return paid incentive dollars and can potentially be hit with monetary fines for false attestations.

A Case Study – Losing Big

In 2013, a large medical group had designated one individual to handle the Meaningful Use project for all of its 60+ providers. This individual simply worked in the medical records department and had no training on the EHR Incentive Program. This staff “successfully attested” on behalf of the providers, all of whom received a $15,000 incentive payment through Medicare. In 2015, a single provider from this organization was chosen for an audit of his 2013 reporting year. Through this audit, it was discovered they did not administer a complete security risk assessment and had not enabled the clinical decision support tool in their EHR, but had attested to fulfilling these requirements. Their notice from CMS read:

“Based on our review of the supporting documentation furnished by the practice, we have determined that you have not met the meaningful use criteria……..Since the provider did not meet the meaningful use criteria, the EHR incentive payment will be recouped. You will receive a demand for your total Medicare EHR incentive payment shortly from the EHR HITECH Incentive Payment Center.”

Not only did this provider have to return the $15,000 incentive payment after a rejected appeal, but the rest of the organization was now facing a required internal audit. The internal review did in fact reveal that all of the Eligible Professionals who received an EHR incentive payment for 2013 reporting year had falsely attested, due to the unpreparedness and lack of training of one individual. In total, the organization had to return almost one million dollars in incentive payments. The concern quickly grew from simply having to pay back the one million dollars into “where are we going to get $1,000,000??”, as the incentive payment had long since been spent. This group had to cut costs to acquire the funds, staff lost jobs, and the quality of their overall services and patient care were directly affected.

How To Protect Yourself

While this example is an extreme case due to the amount of the repayment, the basic tenets of the story are applicable to thousands of healthcare providers across the country. To ensure you don’t run into these problems, the most basic approach is to ensure you have a comprehensive plan for documenting and reporting for incentive programs before you ever begin the process. Obviously, that train has left the station for most providers as it relates to Meaningful Use, but you can still perform reviews of your workflows, reporting measures, and attestation details to ensure that all of your documentation is in place and that you can properly account for all of the moving pieces during a random audit.

Whether you are in the midst of a reporting year, facing a required MU audit, or concerned about compliance with past year’s attestation, it is best to consult with an MU/HIPAA subject matter expert to review documentation and compliance. The assistance can be priceless.

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