Feds restore $250K in Medicare reimbursements for DeWitt practice after reviewing clerical error

DeWITT, N.Y. — The federal government has decided not to withhold $250,000 in Medicare reimbursements from DeWitt–based Hematology-Oncology Associates ofCentral New York (HOACNY) after initially saying it would.

The Centers for Medicare & Medicaid Services (CMS) took time to “revisit a simple data-entry error that wrongfully changed” HOACNY’s performance, quality, and reimbursement total, U.S. Senate Minority Leader Charles Schumer (D–N.Y.) and U.S. Representative John Katko (R–Camillus) said in a news release issued by Schumer’s office.

When submitting annual performance data to CMS, HOACNY staff accidently inputted the letter “I” instead of the number “1.” The “simple” error — one that CMS “would not initially” correct — reduced HOA’s Medicare reimbursement by $250,000, the lawmakers said.

The situation
HOACNY participates in Medicare’s oncology-care model and is the only certified oncology medical home in New York, Schumer and Katko explained.

The federally administered program requires participants to submit annual performance data which are known as “value modifier.”

Instead of reporting 1P to identify patient cases, HOACNY “accidentally” inputted IP into the modifier.

The error “triggered” a negative reimbursement of $250,000 and would have “unfairly” cost the practice and could have led to staff cuts. Hematology-Oncology Associates of CNY appealed to revise this determination, but CMS ruled against a revision citing “agency rules and regulations,” the lawmakers said.

Schumer and Katko say they then “intervened on behalf” of HOACNY.

The lawmakers appealed to CMS administrator Seema Verma and asked her to reconsider the clerical error.

Schumer and Katko argued that reducing HOACNY’s Medicare reimbursement by more than $250,000 due to a data-entry error was “overly punitive and lacked common sense.” At the same time, they also pointed out that it does nothing to advance the interests of the Medicare and Medicaid programs nor reflect “Congressional intent” regarding the value-modifier program.

CMS ultimately reversed its decision and “saw the light,” Schumer and Katko said.

“We are so grateful that CMS was pushed to be reasonable by Senator Schumer and Congressman Katko. A simple clerical error resulted in a devastating loss of revenue, and possibly staff,” Maryann Roefaro, CEO of HOACNY, said in the lawmakers’ news release.

Contact Reinhardt at ereinhardt@cnybj.com