Home Health & Hospice Week

Industry Note:

CERT Report Pushes Prior Auth

Only DME rivals the home health error rate.

The “Medicare Fee-for-Service 2015 Improper Payment Report” that Medicare, the Medicare Payment Advisory Commission, and others have been citing for months is officially out. The Centers for Medicare & Medicaid Services posted the report based on Comprehensive Error Rate Testing reviews, which holds the infamous 59 percent error rate for home health claims reviewed, at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/CERT/Downloads/2015_Improper_Payments_Report.pdf last month.

Overall, CMS saw a decreased fee-for-service improper error rate from 12.5 percent to 12.1 percent from 2014 to 2015. Most other provider types saw single-digit error rates, or at least those in the low teens. The exception was Durable Medical Equipment suppliers with a 40 percent error rate.

Not surprisingly, the report advocates “expanded use of prior authorization in the Medicare FFS program.”