Home Health & Hospice Week

Payment error rate drops by more than half.

Following the recent trend, hospices are bumping home health agencies out of the fraud-and-abuse spotlight.

In this case, the Department of Health & Human Services profiles hospices as one of the four biggest drivers of Medicare improper payments, according to the agency’s recent Agency Financial Report for Fiscal Year 2023. (The other three are skilled nursing facilities, hospital outpatient departments, and inpatient rehab facilities.)

At least hospices have the lowest volume of improper payments at $1.3 billion. That compares to $4.8 billion for SNFs, $4.0 billion for hospital outpatient, and $1.9 billion for IRFs, the report says.

“Insufficient documentation is the major error reason for hospice claims,” HHS says in the report. “The primary reason for these errors is missing or insufficient documentation to support the certification or recertification.”

However: “The improper payment estimate for hospice claims decreased from 12.04 percent in [reporting year] 2022 to 5.36 percent in RY 2023,” HHS points out.

HHS does identify home health as one of Medicare’s “high-risk service areas,” however.

The report mentions the array of program integrity measures HHS has taken in the home health and hospice arenas, ranging from the Review Choice Demonstration to site visits of all hospices.

Overall, the Medicare fee-for-service error rate for 2023 is 7.38 percent, which totals $31.2 billion. More than half of the errors are due to insufficient documentation, HHS reports.

The 304-page report is at www.hhs.gov/sites/default/files/fy-2023-hhs-agency-financial-report.pdf.