Home Health & Hospice Week

Face-to-face continues to be a challenge.

One of the states with the highest payment error rates under the Comprehensive Error Rate Testing program might surprise you.

Reminder: The Centers for Medicare & Medicaid Services “established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments,” HHH Medicare Administrative Contractor Palmetto GBA notes on its CERT webpage. “The CERT program measures the error rate for claims submitted to Medicare contractors.”

Furthermore, “Palmetto GBA uses CERT reports to identify areas of focus for our Provider Outreach & Education efforts,” the MAC says.

Palmetto recently posted state-by-state data for its region based on the 2020 report, and identified Texas, Illinois, and Oklahoma as having the highest error rates based on claims denied. Texas racked up a 25.4 percent claim denial rate, Illinois 20.3 percent, and Oklahoma 18.8 percent, the MAC says on its website.

Observers may be surprised that Illinois’ error rate was so high, given that it previously underwent the Pre-Claim Review demonstration and went back under the Review Choice Demonstration last June. But the latest CERT report, which covers the 2019 fiscal year, includes data from July 1, 2017, through June 30, 2018, CMS points out on its CERT website.

Jurisdiction M states on the other end of the spectrum were New Mexico with 0 percent of claims denied, Arkansas with 1.7 percent of claims denied, and Louisiana with 2.9 percent of claims denied.

Reasons for denials mostly fell under the category of insufficient documentation and included face-to-face, physician signature, and OASIS issues, among others.

Access the state-by-state stats, which also include the dollar figures denied, for the 15 Jurisdiction M states by going to www.palmettogba.com, clicking on “Jurisdiction M Home Health and Hospice MAC” in the right-hand column, selecting “CERT” from the “Topics” pull-down menu in the top bar,” selecting the “General Information” link, and scrolling down for the articles listed by state.