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.
With a minimum of 5-10 percent of EPs getting audited, this is the final nail in the coffin of the MU program. Soon they will have to audit the same 10 practices as everyone has given up on MU. Classic that CMS denied his in person claim to clarify the situation. This one should be sent to their federal representatives and the leaders of ONC and CMS. Hello Karen? Marilyn? Sylvia? To get similar treatment as an IRS audit, is very disheartening.
This is absolutely ludicrous and I believe the government needs an anatomy lesson regarding which end you are supposed to speak from. I agree with the previous response, speaking as a practice that has been audited and found against, that everyone SHOULD give up on “meaningful use” at this point, as I believe CMS has made it perfectly clear that they never had any intention of allowing providers to keep their incentive money. They dangled the carrot, threatened and scared everyone with the punishment of decreased reimbursement and, now that they got what they wanted (all the data to allow the insurance companies to use against the American public), they are literally stealing our money back from us. We have all spent thousands of dollars on equipment, programs, scanning etc., and thousands of our valuable hours to help them accomplish their goal, and all we are getting is kicked in the teeth. To all doctors out there, it is time to take medicine back!