How Meaningful Use Increases Audits

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.


Knicole C. Emanuel Esq.

For more than 20 years, Knicole has maintained a health care litigation practice, concentrating on Medicare and Medicaid litigation, health care regulatory compliance, administrative law and regulatory law. Knicole has tried over 2,000 administrative cases in over 30 states and has appeared before multiple states’ medical boards. She has successfully obtained federal injunctions in numerous states, which allowed health care providers to remain in business despite the state or federal laws allegations of health care fraud, abhorrent billings, and data mining. Across the country, Knicole frequently lectures on health care law, the impact of the Affordable Care Act and regulatory compliance for providers, including physicians, home health and hospice, dentists, chiropractors, hospitals and durable medical equipment providers. Knicole is partner at Nelson Mullins and a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

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