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Wednesday, December 18, 2019

Medicare audit says hospitals may have to give back incentive payments they received by mistake

The federal government may have mistakenly given acute-care hospitals $93.6 million in Medicare incentive payments between January 2013 and September 2017, according to an audit from the Department of Health and Human Services' Office of Inspector General, Jessica Kim Cohen reports for Modern Healthcare.

The Centers for Medicare and Medicaid Services will try to get hospitals to pay some of the money back, Cohen reports. That could hurt some rural hospitals already hurting financially; many of them are especially dependent on Medicare.

The payments were distributed as part of an incentive program, last year renamed the Medicare Promoting Interoperability Program, that was meant to encourage hospitals to use electronic health record systems. "The OIG attributed the errors to Medicare administrative contractors not properly reviewing information from hospitals' cost reports, which are used to calculate incentive payments. Some cost reports included errors like hospitals using data for more than 12 months and incorporating services other than acute-care services," Cohen reports. "The CMS also neglected to include some required services in its incentive payment calculations, such as labor and delivery services, as well as some services related to intensive-care units."

The OIG reviewed a sample of 99 payments out of the 8,297 payments made in the audited time period. Those payments totaled $152.2 million, and $1.3 million were incorrect—less than 1 percent. They came up with the $93.6 million figure by extrapolation, Cohen reports. The OIG recommended that CMS instruct Medicare administrative contractors to review all hospitals' records to see if there are any more such errors and attempt to recover only non-final payments.

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