Meaningful Use Overpayments – Will You Owe Money Back?

meaningful use overpayment“Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments to Noncompliant Eligible Professionals.”  Office of Inspector General, Feb 16, 2017.

And…CMS looks forward to receiving referral files, will review them, take appropriate steps, and recoup medical payments in accordance with the its policies and procedures.  This statement specifically speaks to the OIG’s determination that $2,334,680 in overpayments were made to eligible professionals (EPs) that switched their Medicare/Medicaid (incentive) program midstream while reporting meaningful use measures that were made and paid in the wrong payment year.

The OIG and CMS are not limiting overpayment recoupment efforts to only those EPs described above, it is estimated that 12% or $729,424,395 in payments to providers that collected meaningful use incentive payments were overall improper payments and the government wants the money returned.  A random sample size of 100 EPs was conducted where it was found that 14 EPs received $291,222 for improper payments made by CMS due to the EPs not maintaining support for their required attestations.  CMS’ response is that they will work with its contractor to recoup any overpayments.

Meaningful Use required that EPs demonstrated that they are using certified EHR technology that includes electronic prescribing, electronic exchange of health information for care coordination, 50% of the EP’s encounters during the reporting period were performed in a location that utilized certified EHR technology, and that a security risk analysis with identified and implemented corrections occurred.  Did these things happen and were they reported correctly in your organization?

Because these incentive payments to EPs legally authorized to practice medicine and maintain an active NPI number, an NPI number must be deactivated within 60 days of the death of the provider.  The OIG found that CMS paid $11,760 to an EP (not part of the sample) that died during the reporting period.  Further, included in their sample, it was revealed that 11 deceased EPs were not deactivated within the 60-day timeframe and 2 of the deceased were still active in the identification and payment systems as of the date of this report (June 2017).

Targeted risk-based audits to strengthen CMS’ program integrity began in 2017 and are expected to continue until millions of dollars have been repaid or recouped.  Since CMS made EHR incentive payments to noncompliant eligible professionals and it has vowed to recoup the money, it’s more than time to verify the data reported, attestations submitted, conduct a security risk analysis, and make and document appropriate corrections.  Meaningful use documentation is to be retained for 6 years, so if you think you or your staff may have missed anything in completing and reporting incentivized quality measures, assess your business and make corrections now rather than later.

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