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Category : Latest News

Posted : Tuesday, July 11, 2017
Edited By : chase carter
Friday, December 6, 2019

CMS Meaningful Use Overpayments – The Potential Impact to You and Your Practice

chase carter

Many healthcare organizations were shocked to find that the Centers for Medicare and Medicaid Services (CMS) overpaid more than $729 million worth of incentive payments to eligible providers that failed to meet meaningful use requirements. This discovery was brought to light after a report was released by U.S. Department of Health and Human Services’ Office of Inspector General (OIG).

This is almost a quarter of a billion dollars, taxpayer dollars to be specific, awarded to some providers who didn’t deserve it and now all eyes are on CMS to fix the problem.

If you find yourself asking how in the world could this have happened? You are not alone. Thankfully the Office of Inspector General has provided us with a three word explanation: Lack of documentation.

These payment errors occurred because sampled EPs did not maintain support for their attestations. That’s right, those Meaningful Use Audit Binders we keep mentioning every year just got yanked into the spotlight and are more important than ever.

Why are they important now? Well let’s take a look at the OIG’s recommendations to CMS for a corrective action plan, they are:

  1. Recover $291,000 in payments made to the sampled EPs who did not meet meaningful use requirements;
  2. Review EP incentive payments to determine which EPs did not meet meaningful use measures for each applicable program year to attempt recovery of the $729.4 million in estimated inappropriate incentive payments;
  3. Review a random sample of EPs' documentation supporting their self-attestations to identify inappropriate incentive payments that may have been made after the audit period;
  4. Educate EPs on proper documentation requirements;
  5. Recover $2.3 million in overpayments made to EPs after they switched programs; and
  6. Employ edits within the National Level Repository system to ensure that an EP does not receive payments under both EHR incentive programs for the same program year.

What does this mean for providers? Audits.

OIG recommends that CMS figure out which providers didn't meet meaningful use criteria and try to recover the overpaid money. The agency can do so, OIG said, by looking over its incentive payments and conducting a random sample of providers' documentation.

The new CMS administration responded to the findings saying it “is committed to turning the page and ushering in a new era of accountability”. CMS officials also stated, “Providing high-quality care to Medicare beneficiaries while being responsible stewards of taxpayer dollars remains a top CMS priority, and we recognize the value data validation and auditing bring to our programs.”

Translation: More Audits.

Still not convinced?

The OIG is openly accusing CMS of leaving the program exposed to abuse, stating “CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable to abuse and misuse of Federal funds.”

CMS tried to defend itself stating the agency has implemented targeted risk-based audits to strengthen the integrity of the program. OIG countered that, “Targeted risk-based audits are not capturing errors such as those identified in this report.”

Translation: Audits, Audits, and more Audits.

Officials even went as far to say, “As CMS implements MACRA, we recommend that any modifications to the EHR meaningful use requirements include stronger program integrity safeguards that allow for more consistent verification of the reporting of required measures.”

Ouch, that one hurt. But here’s a question for you, was this overpayment unavoidable? The distribution of funds analyzed in this audit occurred between the years of 2011 – 2014 while the program was still in its beginning stages. Could these payment mistakes simply be a result of getting a new program off the ground?

 According to Jeff Smith, vice president of public policy for the American Medical Informatics Association, "Twelve percent sounds pretty alarming, but I would imagine that it's probably within one or two standard deviations of the mean for other CMS programs."

"This kind of thing happens in new programs," said former CMS head Gail Wilensky of the overpayments. "When it happens, you want to get it fixed, and if it continues to happen, that's more disturbing than having surfaced it early in its existence."

One solution could be better audits, Wilensky suggested, "There's no reason the CMS can't do spot audits.”

Whether this overpayment was unavoidable or not, it has shifted the spotlight onto the Meaningful Use program and its incentive payments, meaning an increase in audits is unavoidable. As such, it may be wise to pull your own audit binders out and make sure you have the documentation needed to support a CMS Meaningful Use Audit. 

Lindsey Lanning, Healthcare Compliance Consultant at Itentive Healthcare Solutions