Meaningful Use Pre-Payment Audits on the Rise

Wednesday, February 18, 2015

Individual using medical tabletDemonstrating Meaningful Use is one thing. Receivng your check is another. Recent adjustments to the way hospitals/providers are audited has resulted in an increase inpre-payment audits. These audits have beenon-going since 2013, with an estimated 10% of hospitals and 5% of eligible professionals per state audited annually.Providers selected for audits will have to provide data to back their attestation or validate their submitted data before CMS will release their bonus payment. Here's what you need to know to plan for a potential audit:

In general for Medicare attestation-related audits:

  • Medicare pre-payment audit requests became more robust in late 2014, early 2015 with 2014 attestations.
  • Medicare post-payment audit notifications generally arrive up to two years after attestation.

In general for Medicaid attestation-related audits:

  • Medicaid pre-payment audits became standard for hospitals/providers in mid-2014. Attesters must submit documentation via the MAPIR at the time of attestation and this data will be reviewed prior to payments being rendered.
  • Medicaid post-payment audit notifications generally arrive up to two years after attestation.

Maintaining proper and sufficient documentation is vital for passing an audit with minimal burden. Be sure to save all needed screen shots (i.e. proof of functionality enabled), dashboard reports, one-time task completion documentation (i.e. security risk assessment documentation) per hospital/provider in a folder that is accessible by more than one person in the office.

Additionally, if a CMS Frequently Asked Question (FAQ) was used to interpret how an objective relates to your scenario, be sure to save a copy of the FAQ in your documentation, as well. As FAQs become obsolete, CMS removes them from the website which places the burden on hospitals/providers to prove that the FAQ existed and was applicable in the timeframe they attested.

If you receive an audit notification and need guidance, please contact your Purdue Healthcare Advisors' project manager or submit your question to our Help Desk.

Allison Bryan-JungelsAllison Bryan-Jungels, MS, CHES, serves as Senior Advisor-Buisness/Client Development for Purdue Healthcare Advisors. She has spent moe than 10 years in the healthcare sector working both in hospital facilities and the insurance industry.

Writer: Allison Bryan-Jungels, 765-496-9791,

Tags: Quality Services

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