HITECH Audits Defined

By: Michael Smith

Payment Data Audits

The Centers for Medicare and Medicaid (CMS) is currently, on an ongoing basis, providing Medicare Administrative Contractors (MACs) with lists of providers for the MACs to conduct payment data audits. These audits will be selected annually by CMS based on providers which pose the greatest potential for cost savings to the program in each of the MAC jurisdictions. The MACs will also have the opportunity to swap a CMS-selected audit with another provider that they may have determined poses a higher risk or would result in higher potential cost savings. These audits will always be performed on a specific cost reporting period.

These audits will impact both the Subsection (d) hospital and Critical Access Hospital (CAH). The audits will consist of the MAC reviewing and verifying the HITECH payment data elements that are used in calculating the HITECH incentive payments. These payment data elements include the following:
 

• Total Days
• Total Discharges
• Charity Care Charges
• Total Charges
• Depreciable Asset Costs (CAH Only)

If selected for a payment data audit, the provider will receive notification from the MAC of the upcoming audit, along with a request for information. Several MACs are subcontracting with outside entities i.e. CPA Firms, to conduct the payment data audits so the notification may actually come from a party other than the MAC. While these notifications should indicate which MAC the audit is identified with, we have seen notifications where this has not occurred. The audits can be conducted as either on-site or in-house engagements. Also, a provider's cost reporting period may be selected for audit even if it has been final settled by the MAC. Any adjustments to the payment data elements resulting from the audit would then need to be changed through the cost report reopening process and the issuance of a revised notice of program reimbursement.

It should be noted that these audits may result in either an increase or decrease in a provider's HITECH incentive payment.

One final note regarding the payment data audits - State Medicaid Agencies are also conducting similar audits to those providers participating in the Medicaid HITECH incentive payment. Providers may receive a separate notification regarding the State audits and many of those are being conducted through the use of subcontractors. The Medicaid audits will not be auditing depreciable asset costs for CAHs but will audit the remaining payment data elements.

Meaningful Use Audits

Audits of the HITECH payment data elements should not be confused with the second form of HITECH audit - the Meaningful Use Audit.

The meaningful use audit is applicable to both eligible providers and eligible professionals. These audits will be applicable to a specific payment year to which a provider/professional is attesting.

In 2012, CMS awarded the Meaningful Use Audit contract to Figliozzi and Company. These audits consist of reviewing if the eligible providers and professionals in fact met all of the core objectives attested to in order to first receive their HITECH incentive payments. To our knowledge, Figliozzi and Company is not subcontracting these audits.

The result of the Meaningful Use Audits could be much more detrimental than the audits of the HITECH data elements. If the results of the audit determine that an eligible provider/professional in fact was not in compliance and did not meet meaningful use criteria, the entire HITECH incentive payment could be deemed an overpayment.

For more information, please contact your Eide Bailly representative.