Home Health & Hospice Week

Industry Notes:

CERT Report Findings To Bring More Claims Scrutiny

Medicare payment error rate continues to be in the double digits.

The payment error rate for the Medicare program has fallen, but not enough to take the heat off health care providers. The overall payment error rate for fee-forservice Medicare was 10.5 percent for fiscal year 2010, according to the latest Comprehensive Error Rate Testing report issued by the Centers for Medicare & Medicaid Services. That's down from the 12.4 percent error rate reported for 2009, CMS notes in a release. But it's still far from reducing the error rate by half, as President Obama has called for.

Note: While CMS cites 2009's error rate at 12.4 percent, last year's improper payment report listed the overall Medicare FFS error rate at 7.8 percent. CMS has instituted changes to "more accurately reflect improper payments and enhanced our efforts to fight waste, fraud and abuse," Health and Human Services Secretary Kathleen Sebelius says in the release. "This year's lower rate reflects those changes and our focus on protecting Medicare." The 10.5 percent error rate represents $34.3 billion in improper payments, CMS says. "The primary causes of errors ... are insufficient documentation and medically unnecessary services," the agency notes.

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