Home Health & Hospice Week

Hospice error rate falls, too.

Medicare has just handed home health agencies ammunition to support their fight against being labeled as fraudsters.

The improper payment rate for fee-for-service Medicare home health services in 2019 was 12.1 percent, says a newly released report from the Department of Health and Human Services. That’s down from a whopping 59 percent error rate Medicare’s Comprehensive Error Rate Testing contractor found for home health claims in 2015; 42 percent for 2016; 32 percent for 2017; and a much lower 17.6 percent for 2018.

The 12.1 percent rate equates to $2.3 billion in erroneous payments to home health agencies last year, CMS notes in the report.

Insufficient documentation was the leading reason for denials by far at 65.1 percent, with medical necessity trailing at 14.7 percent.

However: Even though the error rate fell signif­icantly, home health improper payments still accounted for 7.9 percent of Medicare’s overall erroneous Part A payments, behind only inpatient hospitals (8.8 percent), skilled nursing facilities inpatient (8.8 percent), and hospital outpatient (8.6 percent).

Hospices’ payment error rate also went down, to 9.7 percent compared to 11.7 percent for 2018. The 9.7 percent rate represents $1.8 billion in erroneous payments to hospices last year.

HHS breaks out the error rate for nonhos­pital-based hospices (8.9 percent compared to 11.0 percent in 2018) and hospital-based hospices (18.9 percent for 2019, down from 19.3 percent the year earlier).

Nonhospital-based hospices ranked fifth in the list of highest Part A improper payments at 5.1 percent, and hospital-based hospices ranked eighth at 1.0 percent.

Together, home health and hospices accounted for 14.7 percent of overall Medicare improper payments, according to the report.

States with the highest home health and hospice error rates in 2019 were Mississippi (22.4 percent combined) and Wisconsin (19.4 percent), HHS says.

In a statement released back in November, the Centers for Medicare & Medicaid Services cheered that the Medicare FFS improper payment rate overall “has fallen yet again, and is at its lowest level since FY 2010.”

The overall rate fell to 7.25 percent in 2019, from 8.12 percent in 2018, “the third consecutive year the Medicare FFS improper payment rate has been below the 10 percent threshold,” CMS touted. “Our aggressive program integrity measures lowered the estimated amount of Medicare FFS improper payments $7 billion from FY 2017-2019 to a total of $28.9 billion.”

CMS credited “home health claims corrective actions, including policy clarification and Targeted Probe and Educate for home health agencies,” resulting in “a significant $5.32 billion decrease in estimated improper payments from FY 2016 to FY 2019.”

Note: The 33-page report is at www.cms.gov/files/document/2019-medicare-fee-service-supplemental-improper-payment-data.pdf.