Don’t Get Too Comfortable With That Meaningful Use Payment – Here’s Why

MU overpayment news

When the title of an OIG report is about Medicare paying out hundreds of millions it shouldn’t have, that’s not great news for Medicare or the providers who got those funds. But that’s exactly what a report released June 12, 2017, says: “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements.”

Short version: From May 2011 to June 2014, the OIG estimates CMS paid about $729.4 million in EHR incentive payments to eligible professionals (EPs) who didn’t meet meaningful use requirements. A big part of the problem was that EPs didn’t maintain support for their attestations about meeting program requirements, and CMS didn’t do a lot of documentation reviews to catch this problem earlier, according to the OIG. OIG’s recommendations to CMS include attempting recovery of that $729.4 million.

Let’s dig in to the OIG recommendations and CMS’s responses a little more.

1. Get Back the Money From Improper Payments

Several of the OIG recommendations in the report are about recovering the money paid to providers who didn’t meet meaningful use requirements:

  • Recover $291,222 in payments made to EPs included in the OIG’s sample group who didn’t meet meaningful use requirements
  • Review incentive payments made during the audit period to attempt recovery of the estimated $729,424,395 in inappropriate incentive payments
  • Check a random sample of EP documentation from after the audit period to see if there were more inappropriate payments.

CMS agreed with the first point, but only partially concurred with the second two, claiming it already has implemented targeted risk-based audits to strengthen program integrity. The OIG report states those audits aren’t sufficient to catch the errors it found.

2. Educate EPs on Proper Documentation

Because finding appropriate support for attestations was such an issue in the review, the OIG made this recommendation:

  • Educate EPs on proper documentation requirements.

CMS concurred, agreeing to look into whether more education is needed, but pointed out they do have education available, including a fact sheet.

3. Get Back the Money From Overpayments

The OIG reviewed all payments to EPs who switched between the Medicare and Medicaid incentive payment programs and discovered overpayments, resulting in this recommendation:

  • Recover $2,344,680 in overpayments made to EPs who switched programs.

CMS agreed, asking the OIG to share the EPs’ information.

4. Use Edits to Ensure Switch Doesn’t Lead to Overpayments

To ensure providers don’t receive payment for both Medicare and Medicaid incentive programs when the EP switches, OIG had this recommendation:

  • Employ edits in the National Level Repository (NLR) system to guarantee providers who switch programs during the year get payment for only one EHR program.

CMS concurred, indicating it had already implemented the edits.

Bonus Recommendation: Keep Up the Safeguards for MACRA

One of the changes MACRA brings essentially moves the Medicare EHR incentive program into the Merit-Based Incentive Payment System (MIPS) as Advancing Care Information. So the OIG report includes a note that CMS has got to keep pushing to verify reporting of required measures.

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Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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