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Meaningful Use Audits and the Inconsistent Appeals Process

Posted on November 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you haven’t had the pleasure of a meaningful use audit yet, consider yourself lucky. They are not pretty, but I’ve never met anyone who actually enjoys an audit. Turns out that meaningful use appeals are even worse than most audits. It’s likely because the meaningful use appeals process are so new and they haven’t figured out their processes. However, if you’re a clinic on the wrong side of a new process, that’s not much consolation.

Meaningful Use expert, Jim Tate, has a fascinating look into the inconsistency of meaningful use appeals. Here’s one story he shares that will kind of blow your mind (or at least annoy and scare you).

“Two Set of Rules”: You are not going to believe this one, but it is true. I was contacted last week by a large practice. Two of their physicians had failed audits. Both appealed and won with the statement from CMS: “This is the final determination notice regarding your recent appeal….Based on our review of your Appeal Filing Request, supporting documentation and the Program policies, we have accepted the documentation your provided to support your appeal. Therefore, CMS upholds your appeal.” Sounds great, doesn’t it? However, two months later they received this from CMS: “CMS has reopened the review of your appeal and supporting documentation along with others from your practice. The documentation provided….is unsufficient to support the appeal and CMS is reversing….the decision to uphold your appeal. As a result, the final CMS decision denies your appeal and upholds the adverse audit finding. This decision is not subject to further appeal.” Is it just me or it this a little bit on the crazy side? They received from CMS a “final determination” that their appeal was upheld and then two months were told the “final determination” was being undone, the appeal would now be denied and “this decision is not subject to further appeal.” Both of the letters were signed by the same CMS official. Is it just me or do we need a little sunlight on the inner workings of this process?

Jim is right that there should be a clear process for meaningful use audits and appeals. It’s interesting that Jim tried to go to DC to visit with CMS about the process. Unfortunately, his request was denied. There’s nothing worse than hitting a dead end and people aren’t willing to listen.

Hopefully CMS will hear this story and act. It’s not fair to any organization to get stuck in a bad process.

The Meaningful Use Revolution

Posted on May 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Meaningful Use change is afoot in the world of EHR software. Many doctors, hospitals and EHR vendors were set up to step away from meaningful use stage 2. Many would have filed for an exception, others would have opted out of Medicare, and others would have just taken the penalties on the chin. It wouldn’t have been pretty and the people at CMS/ONC/HHS realized this was happening and had to do something to avoid the meaningful use stage 2 fall out. It wouldn’t have looked good to have billions of dollars of EHR incentive money sitting on the table with no one wanting it.

CMS decided to cover this wound with a bandaid fix that essentially delays meaningful use stage 2. There are still a lot of details of the proposed rule that are unclear. For example, can anyone attest to meaningful use stage 1 or is that option only available to those EHR vendors who aren’t ready for meaningful use stage 2? I’ve sent that question to CMS, but still haven’t gotten an answer.

Can you imagine the fallout if this is indeed the case? Basically they’d be saying, “All of you EHR vendors and organizations that were good and stayed up with the latest regulations are going to have to do more work and attest to the stricter MU2 criteria while we reward those EHR vendors and organizations that weren’t ready for MU2 with a simpler option.” Can you imagine the backlash that would occur if this is indeed what they decide to do? For that reason alone, I can’t imagine them keeping it that way. I think they have to just open up all the stages/certifications to anyone and everyone regardless of your EHR vendor’s readiness for MU2. (Note: I haven’t dug in to see if this is really a viable option or if a 2014 Certified EHR required changes to the software which make it so it can’t do both MU2 and MU1, but I think it should work out fine. For example, CQMs are tied to certification year and not MU stage. Update: Lynn Scheps from SRSSoft sent me the following update “Prior to the publication of the proposed rule, 2014 CEHRT was required for everyone who wanted to earn an incentive in 2014, so part of the certification requirements was that the EHR could be used for stage 1 or stage 2.”)

What’s even more important is that this is really just the start of the meaningful use revolution. I’ve pointed out my article to “blow up meaningful use” a few times before and that message is starting to be shared by other healthcare IT influencers. For example, the title of this post came from a post by EHR certification and Meaningful Use expert, Jim Tate’s post “You Say You Want a Meaningful Use Revolution” which was a great follow up to his “Meaningful Use Zombie Land” post.

It has become really clear that there’s a lot of confusion afoot. The thing people want most from government regulation is clarity and ICD-10 and now meaningful use are suffering from a lack of clarity. John Halamka summarizes this issue really well:

at some point we need to recognize that layering fixes on top of existing Meaningful Use regulation, some of which was written by CMS and some of which was written by ONC creates too much complexity. I have direct access to the authors of the regulations and email them on a daily basis. It’s getting to the point that even the authors cannot answer questions about the regulations because there are too many layers. I realize that we are reaching the end of the stimulus dollars, but as we head into Stage 3, I wonder if we can radically simplify the program, focusing on a few key policy goals such as interoperability, eliminating most of the existing certification requirements, and giving very clear direction to hospitals and professionals as to what must be done when.

I’m glad to see that John Halamka and myself are on the same page. We need to simplify meaningful use and focus on interoperability. That’s a simple and clear message that providers will understand. I was excited that EHR vendor athenahealth offered a similar view in their post “We Should Be Pushing Interoperability Boundaries, Not EHR Certification Timelines.”

Jim Tate has a good call to action to those who care about what’s happening with meaningful use. As of last night, only 8 comments had been made during the public comment period for the meaningful use stage 2 delay NPRM. You can submit your comments on the rule incredibly easy at the following link: http://www.regulations.gov/#!documentDetail;D=CMS-2014-0064-0002 I’ll be taking this post and my “blowing up meaningful use” and modifying them as my comments. I hope you’ll take the time and share your thoughts on the delay and the future of meaningful use.

Mayo Clinic Social Media Residency, EMR Selection, & EMR License Transfers

Posted on July 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While the Twittersphere is flooded with tweets about the #HIT100, I still was able to take a look through all the volume of tweets and find a few good topics that are well worth discussing on this site.

There are some real doozies in this EMR and Health IT Twitter round up. I’d love to hear your thoughts on each of the topics.

Let’s start with this announcement from the Mayo Clinic:

That’s pretty amazing news to consider. I imagine that most doctors won’t like the use of the name “residency” when it comes to this program. It kind of diminishes how much work, effort and learning happens in their residency. In this case I have to agree with those doctors. Use of the word residency for this short “social media residency” is in poor taste. Although, I do like that the Mayo Clinic is placing such value on the use of social media in healthcare.


Amazing counsel!! Read it again and post it on your wall if you’re going through an EHR selection. The other way to deal with this is to not buy until the requested features is implemented. Although, if you go that route, you might be sitting around forever since they may never implement your requested feature.


I’m glad to see Jim Tate tweeting again. I think he was on hiatus for a while. Or maybe I just hadn’t seen him for a while. In the above tweet he links to an article by William O’Toole that does a great job looking at the issues associated with EMR licenses. Well worth a read if you’re purchasing an EHR or if you plan to one day sell or transfer your practice to someone else.

Steve Jobs and Healthcare IT – EMR

Posted on October 7, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I like I’m sure many of you have been a bit overwhelmed by the amazing outpouring of love that’s happened after the passing of Steve Jobs. It was weird for me, because I knew that Steve Jobs health wasn’t good but I was still a bit shocked to see on Twitter that he’d passed away. Certainly a major loss for his family, but the effect will be felt well beyond them.

I’ve been touched by a number of posts throughout the healthcare IT and EMR blogosphere. Here’s a roundup of a few of the Steve Jobs posts I found.

Jim Tate did a post that considers what if Steve Jobs had developed an EHR. Here’s one section:

For the past 5 years I’ve kept hoping that Apple would develop an EHR. One that when someone first used it they would say: “Yes, this is how it should be”. Whatever he developed and released to the world didn’t even need an owner’s manual. It just worked in a very human way.

I know I’ve written about the possible Apple EHR as well and what it might look like. As I read Jim’s post I couldn’t help but wonder if the reason Steve Jobs didn’t take on a project like an EHR was because our regulations and reimbursement don’t work in a human way.

Dr. Liu on Kevin MD wrote a post about Steve Jobs as a physician mentor. I love the idea that Steve Jobs was his mentor even though they never met. He offered this heartfelt thought:

I as a doctor I’m incredibly sorry that medicine has not yet evolved to the point that a cure exists for the rare type of cancer Jobs. I’m sorry that he is so ill at an incredibly young age, in his mid 50s, when many people begin to contribute even more to society with all of the knowledge and experience they’ve acquired. The future might be a little less bright without Jobs leading his team at Apple on creating products and experiences none of us truly knew existed until he showed them to us.

It is such a shame that he died so young. In fact, I’d say that might be the hardest part of it all.

The self professed Mac Fan boy, John Moore from Chilmark research, paid a tribute as well. He highlights some of the key things that Steve Jobs did with Apple products:
-Design aesthetics combined with functionality rule
-Supporting a renegade
-Systems rather than parts
-Supporting innovation

Yep, Steve Jobs will be missed in healthcare and well beyond.

Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why

Posted on June 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The CMS FAQ site has a great question up that I have a feeling a number of doctors will be interested in knowing the answer to:
I am an eligible professional (EP) who has successfully attested for the Medicare Electronic Health Record (EHR) Incentive Program, so why haven’t I received my incentive payment yet?

Here’s their answer:

For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until l the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

This is actually something that I’ve written about before (probably on EMR and HIPAA), but I have a feeling many people weren’t looking at the details to realize why they aren’t getting their incentive money. You have to wait until you have enough Medicare Allowable Charges before they’ll pay you. I think this is a smart plan I do find it interesting that there were some clinics that had enough allowable charges in 3 months to receive the full EHR incentive money right away. I’d love to see some stats on medicare allowable charges per provider. Would be interesting to see how this aspect of the EHR incentive program affects Medicare providers.

Either way, hopefully this information will help someone who is wondering where they EHR incentive money is. Thanks to @jimtate for tweeting the FAQ and reminding me of this part of the program.

Which EHR Certifying Body?

Posted on March 3, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many of you will probably remember my post about Jim Tate and all his EHR certification experience. As I said in that post, Jim Tate knows his stuff when it comes to the EHR certification bodies (ONC-ATCB). So, I found his advice for EHR vendors on HITECH Answers pretty interesting when it comes to selecting which ONC-ATCB an EHR company should use.

You can go read the whole article, or here’s the Cliff notes version: Responsiveness and Support of the EHR certifying body is most important.

EHR Certification Expert – Jim Tate

Posted on February 17, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


I’ve had a number of EMR companies ask me where they can get help to become a certified EHR. There’s certainly plenty of resources online, but I find that most EMR companies want some real hands on experience and help to be able to navigate the EHR certification process. Whenever I’m asked this question, I always tell those people to go and talk with Jim Tate.

I still remember when I first met Jim Tate at HIMSS last year. I was hanging around the HIMSS exhibit floor because I was early to a meeting with a vendor. I’m sure I was in a partially lost state since I was trying to figure out what to do with the few minutes I had available before my meeting when I heard someone say my name.

I looked up from my lost state to see who was saying my name and saw an all too familiar face for which I couldn’t place. The person then said, “You’re techguy right?” (I’m @techguy on Twitter, and @ehrandhit as well). Then, everything clicked and I said, “You’re Jim Tate right?” See the funny thing was that Jim and I had never met in person, but obviously both of us had seen each others healthcare IT tweets many times before (I think he enjoyed reading my rips on CCHIT pre-HITECH). It’s always interesting (and usually fun) to meet someone in person that you feel like you already know online.

Personal stories aside, I’ve still gotten to know Jim Tate more online than I did in person. I hope that will change at HIMSS this year. Even if it’s just running across Jim on the HIMSS exhibit floor or one of the various parties. Jim has an incredible amount of knowledge and experience in EMR certification. I’m not sure what it says about me that I find the idea of sitting around with Jim listening to old EMR certification “war stories” to be really interesting.

Of course, what prompted my storytelling about Jim Tate? A tweet Jim recently sent that said he’d worked with 90+ HIT vendors. He has a great EMR certification page on his website which has over 75 Ambulatory and Inpatient EMR vendors that he’s worked with. That’s A LOT of EMR companies. You can see the image of EMR companies he’s helped at the bottom of this post.

One ONC-ATCB recently told me that many of the EHR companies that come to them are incredibly well informed, others are just missing some of the details and others are just completely lost. I’m quite sure Jim Tate’s EMR companies fall into the first category.

Now Jim Tate is starting to share his expertise even more broadly as he partners with HITECH Answer and their Virtual Extension Center. Seems like meaningful use consulting will be Jim Tate and EMR Advocate’s next step and probably a very good one. Or as Jim said it:

Jim also gets my funniest tweet of the year award too. In response to @motorcycle_guy’s tweet about who should replace Dr. Blumenthal as ONC head? Jim replied: