Brown Smith Wallace LLC, Missouri’s EHR Audit Contractor
As part of the ongoing program to monitor MO HealthNet’s Electronic Health Record (EHR) Incentive Program payments, the Missouri Department of Social Services has contracted with Brown Smith Wallace LLC to conduct reviews of payments made to participating hospitals and professionals for program year 2013.
Federal regulation 495.368 requires States to comply with Federal requirements to combat fraud and abuse. Brown Smith Wallace LLC is authorized to conduct post-payment audits through desk and/or on-site reviews. Selected hospitals and professionals will receive a letter of notification indicating that they have been chosen for a review.
The purpose of the audit is to validate certain information utilized as the basis for dispersing an incentive payment, including information used in eligibility determinations and hospital payment calculations. Section 1903(t)(2) of the HITECH Act states that all Eligible Professionals and Hospitals need to meet certain patient volume thresholds in order to be eligible for Electronic Health Record incentive payments.
Information Required of Eligible Professionals and Hospitals
The following information may be required from eligible professionals and hospitals. A tip sheet with more detailed descriptions is referenced in the last bullet under each heading below.
Eligible Professionals:
- Detailed encounter listing to support the numerator and denominator utilized in the eligibility calculation,
- Documentation to support an eligible professional’s affiliation with locations for which patient encounter volume was reported,
- Documentation to support an eligible professional’s affiliation with a group practice when that eligible professional utilized the group proxy to report encounter volume, and
- When appropriate, documentation to confirm the provider or provider organization had a legal or financial obligation to the Certified Electronic Health Record Technology at the time of A/I/U (Adopt, Implement, or Upgrade) attestation.
- A tip sheet for eligible professional: https://dss.mo.gov/mhd/ehr/pdf/post-payment-review-tips-eligible-professional.pdf
Eligible Hospitals:
- Detailed encounter listing to support the numerator and denominator utilized in the eligibility calculation,
- Documentation to support discharges according to the applicable cost reports or other documentation utilized in calculating the growth rate and discharge-related amount,
- Documentation to support the Acute Medicaid Days, Acute Medicaid HMO days, and Total Acute days utilized in calculating the Medicaid share,
- Documentation to support Charity Care Charges and Total Hospital Charges utilized in calculating the Medicaid share, and
- When appropriate, documentation to confirm the hospital had a legal or financial obligation to the Certified Electronic Health Record Technology at the time of A/I/U (Adopt, Implement, or Upgrade) attestation.
- A tip sheet for eligible hospitals: https://dss.mo.gov/mhd/ehr/pdf/post-payment-review-tips-eligible-hospitals.pdf