Home Health & Hospice Week

Home care providers can brace for more scrutiny of their Medicare billings in light of new payment error rate data from the Centers for Medicare & Medicaid Services.

CMS Nov. 14 announced its national Medicare improper payment rate findings for fiscal year 2003. The results: Overall, the error rate is holding steady with a 5.8 percent rate in 2003. That's comparable to the 6.3 percent rates in 2001 and 2002, and down dramatically from the 13.8 percent rate in 1996.

But some classes of providers are making more mistakes than others. CMS says home health agencies ranked second only to physical therapists for the percent of claims paid in error in FY 2003, at 14.88 percent. PTs had an error rate of 18.2 percent.

Durable medical equipment suppliers and hospices also had a relatively high rate of errors, at 9.15 percent and 9.16 percent respectively - sixth and seventh in the list of 26 provider types.

The providers with the fewest errors were ambulance services (4.7 percent) podiatrists (4 percent) and urologists (5.3 percent).

This year's data, for the first time, includes provider-specific, contractor-specific and service type-specific error rates.

"Now that CMS has detailed error rates, we can aggressively target our efforts by strengthening the management of our contractors and ... concentrate on the problems indicated by the error rate," says CMS Administrator Tom Scully. "Our goal is to bring about a dramatic reduction in the Medicare payment errors in the next 24 months."