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EHR Audits & Medicare Enrollment: The Latest Provider Update from CMS

Posted by Matthew Smith on Apr 23, 2013 1:15:00 PM
EHR Audits, CMSThe Centers for Medicare & Medicaid Services (CMS) is the Federal agency under the Department of Health & Human Services (HHS) which administers Medicare, Medicaid, and the State Children’s Health Insurance Program. The CMS EHR Incentive programs are currently open programs for eligible professionals and hospitals to receive incentive payment for participation. Checking in on CMS will be a regular weekly post to keep up with communication coming from CMS on information about these and other related programs.

What Providers Need to Know about EHR Audits

All eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) attesting to receive an incentive payment for either the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program may be subject to an audit. CMS and its contractor, Figliozzi and Company, perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers who are participating in the EHR Incentive Programs. States perform audits on Medicaid providers participating in the Medicaid EHR Incentive Program. In addition to the post-payment audits that have been conducted since 2012, CMS began pre-payment audits this year, starting with attestations submitted during and after January 2013.

CMS to Begin Accepting Suggestions for Potential PQRS Measures and Measures Groups in May

CMS will begin accepting quality measure suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rule-making years. CMS is seeking a quality set of measures that are outcome-based and fall into one of the National Quality Strategy (NQS) Priorities domains where there are known measure and performance gaps. The measure gaps that CMS most wishes to fill include clinical outcomes, patient-reported outcomes, care coordination, safety, appropriateness, efficiency, and patient experience and engagement.

Measures submitted for consideration will be assessed to ensure that they meet the needs of the Physician Quality Reporting Program. In addition, CMS encourages eligible providers to submit measures that do not have an adequate representation within the program for participation. When submitting measures for consideration, please ensure that your submission is not duplicative of another existing or proposed measure. Each measure submitted for consideration must include all required supporting documentation. Documentation requirements will be posted on the Measures Management System Call for Measures web page on or around May 1, 2013. Only those measures submitted in the provided format will be accepted for consideration. 

Important Medicare Enrollment Date

Effective May 1, 2013, physicians who refer or order services for Medicare patients will be required to be enrolled in Medicare. Claims submitted on or after May 1st for a physician who referred or ordered services for a Medicare patient but who is not enrolled in Medicare will be denied. Providers should enroll online through the Provider Enrollment, Chain, and Ownership System (PECOS) or can mail enrollment application CMS-8550. Physicians who have a valid opt-out affidavit on file are not required to enroll in Medicare. Visit the CMS web site for more information.

CMS Listening Session on Billing and Coding with EHRs – Save the Date

Friday, May 3, 9am – 2pm ET, Registration Now Open.

CMS and ONC will convene a meeting of interested stakeholders, including providers, health information technology vendors, press and others to discuss electronic health records (EHRs), the increase in code levels billed for some Medicare services, and appropriate coding in an increasingly electronic environment. Invited speakers will discuss key issues such as the impact of EHRs on high quality clinical care, provider efficiency, and coding, as well as coding challenges and opportunities facing various groups, including hospitals, clinicians, and other interested stakeholders.

For this Listening Session, you have the option to:

  1. Attend in-person.
  2. Call-in to listen.
  3. Watch a live stream via the web.
Electronic Health Records EHR Assessment

Topics: CMS, PQRS, EHR Audit, Medicare Enrollment

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