Home Health & Hospice Week

DMERCs have highest error rate of all Medicare contractors.

Health care providers' increased awareness of Medicare's Comprehensive Error Rate Testing (CERT) program is showing results.

The Centers for Medicare & Medicaid Services' 2005 Medicare payment error report puts paid claims errors at 5.1 percent for the period ending in November 2005. That's compared to 10.1 percent last year (see Eli's HCW, Vol. XIV, No. 44).

Providers' increased CERT awareness led them to respond to medical record requests more often, CMS says. And a new policy allowed providers to submit more documentation after the first assessment showed that the records weren't sufficient to make a decision on care necessity, the agency adds.

Error list-toppers: A complete lack of documentation and insufficient documentation accounted for 1.9 percent of the errors. Medical necessity errors were at 1.6 percent and coding errors were at 1.5 percent. Other miscellaneous errors made up the last 0.2 percent.

Durable medical equipment regional carriers had the worst payment error rate as judged by the CERT program, at 8.6 percent. Fiscal intermediaries fared the best with a 3.4 percent error rate.

Home health agencies and hospices fell in the middle of the pack for providers paid by FIs, with error rates of 1.7 percent and 2.0 percent respectively.

CMS broke down DME supplier error rates into many categories, with "Medical supply company with prosthetic personnel certified by an accrediting organization" scoring the best at a 0.0 percent error rate and "Unknown Supplier/Provider" scoring the worst with a 69 percent error rate.

Targets for future scrutiny: A number of DME items or supplies made it into the top-20 error rate list for lack of documentation for all types of contractors ...quot; Oxygen concentrator (E1390), Pressure Reducing Air Mattress (E0277) and blood glucose reagent strips (A4253). Concentrators saw a 1.3 percent error rate and test strips saw a 1.9 percent error rate, while the air mattresses scored a whopping 18.1 percent rate.

Blood glucose strips also made it into the top-20 for medically unnecessary services with an 11.2 percent paid claims error rate for that reason, CMS says.

Home health visits made it onto the insufficient documentation top-20 list with error rates of 1.1 percent for Type of Bill 32 and 0.8 percent for Type of Bill 33, according to the report.

Note: More details are in the 2005 report at www.cms.hhs.gov/CERT.