“Information Blockers” Will Receive Medicare Reimbursement Penalties

The Office of the National Coordinator for Health Information Technology (ONC), in collaboration with the Centers for Medicare & Medicaid Services and the Department of Health and Human Services Office of Inspector General (OIG), released the 21st Century Cures Act: Establishment of Disincentives for Health Care Providers that Have Committed Information Blocking final rule on June 24.

This rule establishes disincentives for healthcare providers—which include an individual clinician, hospital/healthcare system, or an Accountable Care Organization (ACO)—who are found by the OIG to have committed information blocking by knowingly interfering with the access, exchange, or use of electronic health information.

In January 2024, the College submitted comments to the proposed version of this rule, voicing strong opposition to information blocking and highlighting the need for more clarity around how information blocking determinations will be prioritized and applied for providers.

The final rule takes effect on August 1, implementing the following policies:

• A hospital or critical access hospital that has committed information blocking will not receive credit under the Medicare Promoting Interoperability Program, meaning that it will not earn the full annual payment adjustment.
• An individual clinician who has committed information blocking will receive zero points in the Merit-based Incentive Payment System (MIPS) Promoting Interoperability (PI) performance category. Since the PI performance category makes up 25% of the MIPS final score, this could lead to a negative payment adjustment.
• An ACO, ACO participant, or ACO provider or supplier that has committed information blocking may be ineligible to participate in the Medicare Shared Savings Program for at least 1 year. Consequently, the healthcare provider may not receive revenue that it may have earned through the Shared Savings Program during that year. 

Read a fact sheet on the rule.