Brown Smith Wallace, Missouri’s Audit Contractor for EHR Incentive Payments

As part of the ongoing program monitoring efforts for MO HealthNet’s Electronic Health Record (EHR) Incentive Program, 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 2015.  Federal regulations governing the Medicaid EHR Incentive Program require States to conduct these post-payment reviews.

Brown Smith Wallace LLC is authorized to conduct post-payment audits through desk reviews and/or on-site examinations.  Selected hospitals and professionals will receive a letter of notification indicating that they have been chosen for either a desk review or an on-site examination. 

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. 

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 professionals.

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.