Home Health & Hospice Week

Watchdog agency focuses on documentation requirements

Many home care providers feel that Medi- care’s documentation requirements are unreasonable already, but the Government Accountability Office would like to see them get tougher.

In a new report, the GAO reviews the 17.6 percent Medicare improper payment rate for home health claims that the Centers for Medicare & Medicaid Services announced last fall (see Eli’s HCW, Vol. XXVII, No. 42). After a high of 59 percent for the home health claims error rate in 2015, the rate calculated through the Comprehensive Error Rate Testing program fell every year, reaching the 17.6 percent mark for 2018.

After reviewing the processes used to determine Medicare and Medicaid payment error rates, the GAO recommends that “the Administrator of CMS should institute a process to routinely assess, and take steps to ensure, as appropriate, that Medicare and Medicaid documentation requirements are necessary and effective at demonstrating compliance with coverage policies while appropriately addressing program risks.”

The GAO makes three additional recommen­dations aimed at Medicaid error rate calculation, since those rates tend to be significantly lower than the Medicare error rates.

The report is at www.gao.gov/assets/700/ 697981.pdf. CMS’s announcement of the 17.6 percent error rate last November is at www.hhs.gov/sites/default/files/fy-2018-hhs-agency-financial-report.pdf and the detailed CERT report with error rate information issued that same month is at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports.html.