Home Health & Hospice Week

A new way to count Medicare payment errors will likely mean a whole new round of fraud and abuse crackdowns for you.

Under the Obama Administration, the Centers for Medicare & Medicaid Services has "significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009,"

CMS says in a release. As a result, the error rate leapt from 3.6 percent last year to 7.8 percent this year. "The Obama Administration is committed to strengthening and improving the Medicare and Medicaid systems and doing everything we can to be responsible and vigilant stewards of these programs that millions of Americans rely upon," HHS Secretary Kathleen Sebelius says in a release.

The error calculation change will help with the administration's "mandate to root out errors and fraud," Sebelius adds.

The change includes "a requirement that medical information from a health care provider be included to support durable medical equipment claims, in addition to the records from suppliers," CMS notes. That's putting oxygen claims under fire from the Comprehensive Error Rate Testing (CERT) contractor, industry representatives claim.

The CERT contractor is requiring proof of a physician visit within 90 days of a patient's oxygen recertification, reports the National Association for Independent Medical Equipment Suppliers. And CERT audits will require "actual physician notes from that visit," NAIMES claims.

Good idea: Suppliers should collect relevant physician medical records as they go along, NAIMES points out. It can be difficult to obtain such documentation when audit requests come months or years after the visit.

"We strongly urge all suppliers to perform internal audits to ensure that such documentation is in the supplier patient records," NAIMES says.