Home Health & Hospice Week

High claims volume doesn’t necessarily translate to high error rates.

Wondering where the feds might choose to crack down next with stepped up claims review or more intense fraud and abuse-fighting activity? Stats included in the latest Medicare payment error report may give you a clue.

Among the many figures included in the report is a state-by-state breakdown of improper home health and hospice payments combined. The states and territories with the highest improper pay rates are:

1. Puerto Rico, 54 claims reviewed with a 16.4 percent improper payment rate.
2. Nevada, 298 claims reviewed with a 12.7 percent improper payment rate.
3. Georgia, 1,185 claims reviewed with a 12.2 percent improper payment rate.
4. Kentucky, 656 claims reviewed with a 12.2 percent improper payment rate.
5. Alabama, 741 claims reviewed with a 12.1 percent improper payment rate.

Of course, some of those high-error-rate states are not also high-claims-reviewed states. But states with the highest number of home health and hospice claims reviewed tended to have relatively high error rates, including Texas (2,685 claims with 11.0 percent error rate); Florida (2,687 with 8.0 percent); Ohio (1,411 and 11.7 percent) and New Jersey (1,151 and 8.7 percent).

However: Other higher-volume states have low or at least moderate rates including New York (2,057 claims and 4.6 percent), Illinois (1,482 and 5.3 percent), California (3,200 and 6.8 percent), and Massachusetts (1,204 and 4.0 percent).

States with the lowest improper payment rates for home health and hospice are:

1. Montana, 109 claims reviewed with a 1.0 percent improper payment rate.
2. New Hampshire, 220 claims reviewed with a 1.5 percent improper payment rate.
3. Vermont, 83 claims reviewed with a 1.5 percent improper payment rate.
4. Maine, 196 claims reviewed with a 2.2 percent improper payment rate.
5. Rhode Island, 112 claims reviewed with a 2.8 percent improper payment rate.

Note: See each state’s figures in Table B9, p. 22 at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/Downloads/2018MedicareFFSSuplementalImproperPaymentData.pdf.