Medicare improper payments down $7B

The improper payment rate for Medicare fee-for-service declined $7 billion from fiscal years 2017-19 to $28.9 billion, its lowest level since 2010, CMS announced Nov. 18. 

From 2018-19 alone, the Medicare fee-for-service improper payment rate fell from 8.12 percent to 7.25 percent. CMS largely attributed the decrease to progress in areas such as home health, other Medicare Part B services (e.g., physician office visits, ambulance services, lab tests, etc.) and durable medical equipment, prosthetics, orthotics and supplies. 

Corrective actions in home health led to a $5.32 billion decrease in estimated improper payments from 2016-19. Other Medicare Part B services saw a $1.82 billion decrease in estimated improper payments in the last year, and durable medical equipment, prosthetics, orthotics and supplies improper payments fell an estimated $1.29 billion from 2016-19. 

"Our progress on improper payments is historic, but there's more work to be done," CMS Administrator Seema Verma said. "CMS has taken a multifaceted approach that includes provider enrollment and screening standards to keep bad actors out of the program, enforcement against bad actors, provider education on our rules and requirements, and advanced data analytics to stop improper payments before they happen. These initiatives strike an important balance between preventing improper payments and reducing the administrative burden on legitimate providers and suppliers."

 

More articles on healthcare finance: 

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New York hospital audit doesn't show full extent of billing problem

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