The Health and Human Services Commission contracts with an independent audit firm to conduct audits of Texas Medicaid Electronic Health Record Incentive/Promoting Interoperability Program payments to eligible professionals or hospitals, referred to as providers.
Providers can review, respond to, and remediate any adverse findings with auditors following the first audit results notification letter. If any adverse findings are not remediated at this level, the provider can submit a management response to HHSC once the draft audit report is issued. Refer to the Post Payment Audit and Review Process for more information.
Following the issuance of the final audit report, providers can request an informal review by an HHSC-appointed Ad Hoc Review Panel. To request a panel review, a provider must submit the appropriate audit report response form to HHSC within 30 calendar days from the delivery receipt date of the final audit report. Refer to the Post Payment Audit and Review Process for more information.
Ad Hoc Panel Informal Review
Once the case is taken under review, HHSC writes a memorandum to be submitted to the panel. Although not required by law, as a courtesy, HHSC shares its memorandum with the provider (and the provider’s authorized representative, if applicable) before submitting it to the panel. The provider has 21 calendar days from the date the provider receives the HHSC memorandum to write and submit their memorandum to HHSC for review by the panel.
HHSC sends an email confirmation upon receipt of the provider memorandum, and then assigns both memoranda to the panel for review. If a provider fails to respond by the stipulated deadline, the panel reviews the case without the benefit of a provider response.
The provider memorandum must not exceed 10 one-sided pages, with a font no smaller than 12-point, and must include the following information:
- Provider's first and last names
- Provider's National Provider Identification number
- Final audit report detailed findings for which the provider requested a review (cite number of the deficiency or finding from the audit report)
- Explanation of why the provider disagrees with the audit findings
- The provider’s or the authorized representative's signature
Upon request, the panel can access all supporting documentation and evidence in the auditor's work papers and HHSC's case file. A provider can reference existing documentation within the auditor’s work papers and HHSC case file in their memorandum. However, other than the information provided in the audit response form, provider memorandum, and HHSC memorandum, no new supporting documentation or evidence can be submitted or will be considered by the panel.
A provider will not have his or her case reviewed in person by the panel, nor will the provider otherwise communicate with the panel. HHSC will not communicate with the panel regarding the facts of the case, except by means of the written memorandum. However, at the panel's request, HHSC staff are available to answer technical or program-related questions.
The panel is not subject to the Texas Open Meetings Act. Case assignments and subsequent review time by the panel are dependent on panel caseload and scheduling factors.
The panel will issue a non-binding, written recommendation to HHSC. HHSC reviews the panel’s recommendation and makes the final determination. If HHSC determines there were no audit deficiencies, no further action is taken. However, if HHSC agrees with any final audit report finding or deficiency, the commission notifies the provider via letter. If applicable, the provider is responsible for refunding the overpayment of incentive funds to HHSC, which might include recoupment through Medicaid claims from the recipient payee or other collection methods. This concludes the audit review process.
Audit Response Forms
The audit response forms and instructions are available online:
- Eligible Professional Audit Report Response (HHS Form 2702)
- Eligible Hospital Audit Report Response (HHS Form 2703)
The completed audit response form must be received by the applicable deadline by email at EHR_audit_appeals@hhsc.state.tx.us.
Note: If an HHSC receipt confirmation email is not received by the provider or their authorized representative within three business days following the submission of an audit response form or provider memorandum, it is the responsibility of the provider or their authorized representative to contact HHSC.