Nebraska Medicaid Program
Nebraska Medicaid EHR
Part of the Promoting Interoperability Programs
Audit Information and Tips
Nebraska conducts pre-payment audits on all attestations and conducts post payment audits on a number of attestations. This is to ensure accuracy of eligibility both before payments are made and in some cases, after payments have been made.
Why is the State conducting audits of the Nebraska Medicaid EHR Incentive Program payments?
What can I expect if I am selected for a document review or a review at my place of business?
What documents should I be able to provide?
What agencies are conducting post-payment reviews of the incentive payments?
Disclaimer: This is a guide of Audit Tips and is not an all-inclusive list of audit requirements.
Program Integrity within Nebraska Medicaid conducts the post payment audits. Information regarding Program Integrity audits can be found at their website: http://dhhs.ne.gov/medicaid/Pages/med_pi_index.aspx
Audit Tips for Eligible Hospitals
Audit Tips for Eligible Providers
The Final Rule issued by the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) requires that the states have a process in place to provide oversight of the expenditures for the Medicaid EHR Incentive Program. Because the Nebraska Department of Health and Human Services is accountable to CMS for the incentive payments made, we conduct audits of some incentive payments. It is possible that you might be selected for an audit for any incentive payment year.
You will receive a notification via e-mail that will indicate if the audit will be completed as a document review or a review at your place of business. This notification is sent to the contact individual identified as the representative of the provider at the CMS EHR Incentive Program Registration website. The e-mail will list the initial documentation needed to complete the review. Depending on the information provided, the State Reviewer may request additional information. Failure to document eligibility or failure to cooperate with the State Reviewer may result in recoupment of an incentive program payment. DHHS will notify you of the results of the audit. If you do not agree with the results, you may appeal the decision in accordance with the Nebraska appeal process.
All information under attestation is subject to audit. Documentation to support all attestations must be retained and readily available for six years from the date of submitting your attestation.
If the data for the hospital payment calculation differs from the Medicare Cost report (such as amended cost report data or intent to amend the cost report data) the eligible hospital must maintain all work papers to substantiate this calculation.
A few examples of documentation includes dashboard screenshots of meaningful use and clinical quality measures. You must also maintain documentation supporting exclusions and “yes/no” attestation questions. Additionally, you must maintain documentation of the Security Risk Analysis that was performed within the proper time window.
In addition to the Nebraska DHHS State Reviewers, the federal government and its contractor are also conducting post-payment reviews. You may be contacted by the Office of Inspector General (OIG) or CMS.
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