You know that meaningful use check you got from the government?  Did you know you may have to give it back and possibly more?  Meaningful Use 1 and 2 audits, and now “pre-audits,” appear to be happening at an ever increasing rate.  Are you doing what you should to not only prepare for such an audit but to properly execute the steps needed for MU2? Many doctors have found the process to be so onerous that they are avoiding it all together and forgoing the possible incentive money. What’s your strategy?

2014 has seen over 11,000 audit performed and 2015 target seem to be higher.  On average 25% of post payment audits result in failure and result in some repayments, while 25-33% of pre-payment audits result in failure.

The key to survive an MU audit is to make certain you have all the documentation required and that the documentation is dated and clearly identified for the reporting period it addresses.  The key is that your reports clearly identify the provider, the measurement and the period you are reporting.

The audit will focus primarily on verifying that the information is valid for the period and for the specified provider.  Documentation and screen shots of activities and verification that all meaningful use features were active during all the period you are reporting will also be required during the audit. Auditors want to make certain that the data reported is for the period, provider and not partial or incorrect.  To be able to verify this, they want proof that your software cannot be circumvented or features turned off or data altered to make the reports meet the requirements. They also want to make certain that the reports generated are valid. Make certain you have this information (clearly documented with supporting letters from patients, vendors, etc..)  beforehand because trying to get the information after the fact may be difficult to impossible. The best policy is that you want to conduct your own mini-audit from time to time to make certain that all your data is being captured and that what you are reporting is true. Having this test/verified  data will help prove that your MU reports are valid.  For example, for your portal, if you say you had x number of patients using it.  Get a sample of your visitors to sign a letters confirming that they actually did go to your portal during the selected period. Having this type of confirmation goes a long way to proving that the numbers are valid.

The other issue you may face during the audit is the HIPAA Security Risk Analysis document.  This document is a living document which must exist and be maintained.  This is one of the first item which may cause a failed audit.  Make certain that you have properly addressed the HIPAA Security Risk Analysis requirement prior to attesting for Meaningful use. Auditors will ask for your documentation and then want to verify that what is documented is being followed.  They will want to review items like your password policy, physical security, reviews and the likes.

Providers which have received Meaningful use payments and fail the audit may be forced to refund their payments and if the auditor believes that the provider was negligent or not forthcoming may apply additional fines to the repayment.  Repayments can range from $0.00 to  $18,000 to several $100 thousand dollars depending on the size of the practice and the amount paid out by Meaningful Use prior to the audit.

The best strategy is to not place yourself in such a position of having to repay immediately your meaningful use payments.  Make certain that if you decide to certify for meaningful use, that you can pass successfully an audit. The effort required to meet the MU certification is significant but totally required for a successful audit.

Another option you may want to consider is that insurance companies are now starting to provide insurance policies for meaningful use.  Reputable insurance companies are not in the habit of paying out unnecessary claims, therefore if you purchase MU insurance, they will force you to make certain that you are ready for an audit and that the odds are with you for passing the audits. But if you did everything right and still fail the audit, they will help you make the repayment.