Medicare Compliance & Reimbursement

Here’s a breakdown of the Medicare fee-for-service overall improper payment rate projections for fiscal year (FY) 2020:

• Part A with Hospital IPPS: The feds found a 14 percent improper payment rate among Medicare Part A with hospital inpatient prospective payment system (IPPS) claims.
• Part A without Hospital IPPS: A staggering 42.4 percent of Medicare Part A excluding hospital IPPS claims were part of the overall error rate. Despite this high number, this category saw a big decline in 2020, dropping down from 46.1 percent in 2019.
• Part B: The CERT data showed Medicare Part B’s portion of the improper payment rate at 32.8 percent of the overall amount — up significantly from its 2019 rate of 29.9 percent.
• DMEPOS: According to the CERT results, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) accounted for 10.8 percent of the total error rate, a 2.3 percent jump from its 2019 improper payment rate of 8.5 percent.