Although it’s been around for over half a century, there’s a very real possibility that Medicare won’t last much longer. According to Medicare’s Board of Trustees, the trust fund for Medicare Part A will run dry by 2026, while Medicare Part B spending is only growing. In response, the Office of Inspector General (OIG) has introduced several cost-saving measures that should be implemented as soon as possible. Unfortunately, many of them are easier said than done.
Of these suggestions, one of the most talked-about is the recommendation that the Centers for Medicare and Medicaid Services (CMS) should “include stronger program integrity safeguards to modifications of electronic health record (EHR) meaningful use requirements.” OIG provided startling evidence into the problems with this notion in the past, claiming that CMS “inappropriately paid $729,424,395 in incentive payments to EPs who did not meet meaningful use requirements. These errors occurred because sampled EPs did not maintain support for their attestations.” In short, CMS needs to spend more time reviewing its claims and ensuring that the documentation actually supports the reimbursement they’re doling out.
On the other side of the equation, practices and facilities should be sure to double-check their claims in order to make sure that they’ve provided proper evidence for their code selections. While receiving more reimbursement that you’re owed may seem like a lucky break at first, it carries far more dangers than even the possibility of an audit. If Medicare funds ever run totally dry, countless practices across the country will lose out on a major source of income. As such, it is up to both ends of the revenue cycle to do their parts to cut down on wasteful spending. Medicare may not be about to disappear in the next few weeks or months, but assuming that the problem is too far away to fight is a surefire way for it to grow out of hand.