Industry Insights

It’s Time to Attest to Program Year 2015 … Are You Ready?

November 2015
Authors:  Michael Orr

Michael Orr

Director

Consulting

Health Care

7901 Woodway Drive, Suite 100
Waco, TX 76712-3897

Waco
254.776.8244

 & Travis Skinner

Travis Skinner

Director

Consulting

Health Care

7901 Woodway Drive, Suite 100
Waco, TX 76712-3897

Waco
254.776.8244

On January 4, 2016, the Centers for Medicare & Medicaid Services (CMS) Electronic Medical Record (EMR) attestation portal will go live, allowing more than 500,000 eligible professionals (EP) and more than 5,000 eligible hospitals (EH) to attest to their scheduled stage of Meaningful Use (MU). The last day of the attestation window for program year 2015 is February 29, 2016.

All EPs and EHs trying to attest at the same time could cause the CMS website to crash, similar to what happened in program year 2013. So making sure you attest as soon as possible is imperative. Alternatively, you might avoid the overload of attesters by trying to attest outside of normal business hours or on a weekend.

Once an EH has successfully attested to program year 2015 for Medicare, another attestation may need to take place. Roughly 24 to 48 hours after the successful MU attestation, the EH’s state Medicaid EMR incentive program application should open for them to attest for their subsequent year’s Medicaid incentive payment, if any are left. The deadline to attest to the Medicaid EMR program is state-specific.

Virtually all EHs should qualify for the Medicaid EMR program. If your EH isn’t in the Medicaid EMR program, we suggest having your data reviewed to avoid potentially leaving considerable money on the table.

In addition, even if an EH already is in the program for multiple years, other prevalent issues could affect EHs:

  1. The Office of Inspector General (OIG) is investigating payments by state—and finding out how poorly many third-party vendors implemented the Medicaid EMR program. Based on OIG findings, numerous EHs are being required to repay significant overpayments. If an EH is undergoing an OIG audit or any other type of Medicaid audit, positive adjustments may be able to help offset potential negative adjustments.
  2. On the opposite end of the spectrum, EHs also may find they’ve been underpaid based on the OIG findings. Multiple areas can be reviewed and adjusted during the application process or through payment adjustment requests that can increase the incentive payment.
  3. If your EH attested to the Medicaid EMR program during program year 2013 or after, there could be opportunity to review your application based on an alternative payment methodology (if allowed by your state’s Medicaid Health Information Technology plan).

All of these potential risks and opportunities can be reviewed before the attestation takes place.

That said, each EP and EH must make sure all of its MU supporting documentation is reviewed; if the EP or EH undergoes an MU audit after the fact and subsequently fails, all incentive payments awarded to the EP (either Medicare or Medicaid payments) or EH (both Medicare and Medicaid payments) from the program year in question will be due back to CMS within 30 days.

These are the two most common situations we’ve seen regarding attesting to and passing MU audits:

  1. An EP or EH that has successfully attested to a particular program year believes it will pass an MU audit because it has a summary report demonstrating it met the MU requirements. In actuality, it doesn’t have all of the needed documentation to support the attestation during an MU audit; all it takes is one missing document for a potential failed MU audit.
  2. The “black box of information” scenario:  Between the time an EP or EH has successfully attested to a program year and its MU audit, the key person in charge of all the MU supporting documentation no longer is part of the team—and knowledge of the attestation left along with that key person.

In either of the above situations, among many others, all EPs and EHs should have their MU supporting documentation reviewed before attestation to their scheduled MU stage. This will help them have everything in place and accounted for before the buttons are actually pushed to attest for that program year.

If you have any questions, contact your BKD advisor.

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