Home Health & Hospice Week

The Centers for Medicare & Medicaid Services is eating its words, or rather its numbers, as far as home care billing is concerned.

CMS issued a report summary Nov. 14, saying home health agencies and hospice providers were among the providers with the highest rate of billing errors (see Eli's HCW, Vol. XII, No. 42, p. 332). But now a CMS spokesperson says its original report contained errors due to "typos." HHAs and hospices actually are the Medicare program's very best billers, new numbers show.

A tiny 0.6 percent of HHA claims in fiscal year 2003 were paid in error, and only 1.6 percent of hospice claims were incorrectly paid, CMS now says. That puts those provider types twenty-fourth and twenty-third on the list of 25 providers, above only free-standing ambulatory surgery centers.

The originally reported numbers for durable medical equipment suppliers were closer to home, however. DME regional carriers incorrectly paid 9.2 percent of their claims when they shouldn't have, putting suppliers sixth on the list. That's the same as originally reported.

Senate Big-Wig Calls CMS on the Carpet

One lawmaker is calling CMS numbers into question, and it's not for their obvious errors. CMS claims the overall error rate dropped to 5.8 percent in 2003, a touch lower than the rate for the previous two years.

But in Senate Finance Committee Chair Charles Grassley's opinion, thanks to an adjustment CMS and its error-rate contractor AdvanceMed made to the 2003 data, the claimed 5.8 percent rate is "NOT statistically valid, as it had been in the previous six years" when the HHS Office of Inspector General computed it, but "a guesstimate."

Unadjusted, CMS found the error rate to be 9.8 percent - $19.6 billion - 3.5 percent higher than last year and the highest rate since 1997, just one year after the Department of Health and Human Services and Congress began assiduous efforts to bring down the number of improper payments.

However, non-responding providers are included as erroneous payments in the survey. And in this first year of CMS's takeover of the analysis - using a sample size of 120,000 claims, rather than the 6,000 claims annually analyzed by the OIG - "a significant non-response problem developed," with the result that over half of the 9.8 percent unadjusted rate was attributable to non-response, says the agency.

CMS chalked up the non-response rate to one-time glitches - including providers' misconceptions about new privacy regulations, suspicion of record requests coming from an unfamiliar source, and limitations in the CMS shared-data network - and adjusted the numbers to "provide a more meaningful estimate." The agency assumed that, without the unusual factors, this year's non-response rate would be in the ballpark of the average rate from 1996 through 2002 and adjusted this year's figures accordingly.

In an irate Nov. 14 letter to Principal Deputy IG Dara Corrigan, Grassley - who opposed switching the audit to CMS from the OIG - wrote that he's suspicious of the whole enterprise: "Today, CMS and AMC provided Congress with two Medicare error rates, one that is 'adjusted' and the other, which is not." Grassley wants Corrigan to ensure that next year's report will include only one error number, not two, and to monitor CMS's tinkering with the error-counting program, including its plans to decrease the non-response rate.