Audits for meaningful use can equal tens of thousands of dollars.
Today I want to discuss electronic health records (EHRs) and Recovery Audit Contractor (RAC) audits. We all remember the government pushing all providers into purchasing EHR. It was initially known as the Meaningful Use (MU) program, which is now known as the Promoting Interoperability Programs.
The Centers for Medicare & Medicaid Services (CMS) initially provided 10 incentives to accelerate the adoption of EHRs to meet program requirements. Now, physicians who fail to participate will receive a penalty in the form of reduced Medicare reimbursement. Physicians must use certified electronic health records technology (CEHRT) and demonstrate meaningful use through an attestation process at the end of each MU reporting period to avoid the penalty.
Audits for meaningful use can equal tens of thousands of dollars. The monetary amount is not as high as that associated with RAC audits for medical records. One of my clients is a pediatrician in Georgia. His facility received an alleged overpayment of $34,000 for two of his physicians not meeting the MU criteria 8 and 9. We were going to fight it, but the two physicians who were dinged had quit and would not testify positively on behalf of my client. Plus, attorneys’ fees would exceed the penalty. Criteria 8 and 9 constitute proving that your consumers have email and actually open their emails to check their healthcare Internet folders.
On Sept. 2, 2020, CMS published the Medicare Hospital Inpatient Prospective Payment System (IPPS) Prospective Payment System (PPS) Final Rule for acute-care hospitals and long-term care hospitals, which included program requirements for the 2021 calendar year (CY). In this final rule, CMS continued its advancement of EHR utilization, focusing on burden reduction, improving interoperability, and enhancing patient access to health information.
MU’s unanticipated consequence is ramping up RAC audits. Many RAC auditors are using EHR to claim copying and pasting on the part of providers. Obviously, the point of EHR is to morph all service notes into a certain standard-looking note. But standard-looking notes scream copying and pasting to RAC auditors. Maybe such auditors haven’t fully digested MU yet.
Programming Note: Listen to Knicole Emanuel’s RAC Report Mondays, on Monitor Mondays, 10 Eastern.
Today’s hot topic takes a look through the leadership lens of guiding your teams through a software transition. In my case currently, it is a
External audit volume more than doubled in 2024 over 2023 while total at-risk dollars increased fivefold to $11.2 million, impacting healthcare provider organizations’ cash flow
Please log in to your account to comment on this article.
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s second quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
