Medi-Cal Electronic Health Record (EHR) Payment Alert

As a result of an OIG investigation into the Department of Health Care Services’ (DHCS) previously approved EHR incentive payments, all hospitals that have received Medi-Cal EHR payments are likely to be audited.  The OIG has determined that the calculations of EHR incentive payments were erroneous for a variety of reasons such as:
  • Inclusion of unpaid Medicaid days
  • Inclusion of non-acute services
  • Inclusion of dual-eligible days
  • Lack of supporting documentation
  • Other errors
While hospitals may have followed the instructions provided by DHCS in the claiming of EHR incentive payments, it appears that the specific guidance from CMS may not have been followed.  Every hospital that received EHR payments has a risk of DHCS now finding that an overpayment has been made.
Toyon is available to assist during any such EHR audit and to file appeals on behalf of client hospitals in order to minimize any EHR payment recovery. If your hospital is audited, you will receive an audit report that looks very similar to a DHCS cost report audit report. Once such a report is received, you will have 60 days in which to file an appeal or the audit findings will be final.
Should you wish any assistance on either EHR audits or appeals, please contact Mike Smith at 925-685-9312 or the Toyon staff person assigned to your hospital.
Toyon Associates Healthcare Finance


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