Meaningful Use Audits

It shouldn’t come as a surprise to most healthcare professionals that CMS plans on auditing practices for meaningful use. The introduction of this audit is an effort to curtail the possibility of fraud or abuse within the healthcare system. The Office of National Coordination for Health IT (ONC) had asked the Office of Inspector General (OIG) to conduct the investigation on whether EMRs are being used intentionally or otherwise to commit billing frauds through up-coding etc. against Medicare and Medicaid programs.

Although it remains unclear as to how CMS plans on managing such an expansive audit, most professionals are dreading uninformed random visits by the feds that can potentially disrupt practice operations. General speculation suggests CMS to scrutinize physicians opting out of the meaningful use program having completed the stage 1. However, that does not mean the rest would go unnoticed.

A compliance officer believes that most physicians are used to external audits and will adapt accordingly, “We haven’t had a meaningful use audit before but that does not mean we are not familiar with the procedure. It’s the word ‘Audit’ that has a negative connotation.”

A number of physicians were taken aback when CMS unveiled the proposed requirements for meaningful use stage 2. Many complained that their EMRs lacked the required technology, while others bemoaned the inclusion of measures such as the requirement for patients to use online portals. Physicians overwhelmed by these requirements simply may not wish to comply with stage 2 and a looming audit is likely to act as more of a deterrent then anything. Many Health IT experts are questioning the intent of CMS as such steps may directly affect the rate of EMR adoption.

However, one Health IT expert points that this would help prevent providers planning on gaming the system without actually implementing the EMR, “The Medicaid stimulus is payable to physicians acquiring EMR technology. They just have to present a signed document indicating the adoption.”, adding “This has allowed some to take advantage of the stipulation, setting a poor example for the rest of the care community.”

The audit will evaluate if the physician has effectively performed an operation as reported. “It is common for providers to check options such as risk assessment without actually performing or documenting it. Most providers don’t even know what the task even entails!”, says a Meaningful Use consultant. If a provider is unable to produce the relevant documentation, it would constitute as a fraud and incentives will be recouped accordingly. RECs along with vendors are actively trying to educate physicians in this regard as the plan begins to materialize.


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