Medicare prepayment reviews could save billions lost to billing errors, advocacy group says

The improper payment rate for Medicare fee-for-service fell from 9.51 percent in fiscal year 2017 to 8.12 percent in fiscal year 2018, the lowest rate since 2010, CMS revealed.

While this is good news, it still means Medicare lost $31.6 billion in avoidable billing errors in 2018, according to the Council for Medicare Integrity, a nonprofit advocacy organization focused on combating improper Medicare payments.

Overall, the organization estimates Medicare lost more than $230 billion  in the last six years, not due to fraud, but due to avoidable billing mistakes like coding errors and double billing.

"I would say that the amount Medicare is still losing to waste annually is of greatest concern — especially in light of looming Medicare Part A coverage cuts and additional discussions on Capitol Hill about cutting Medicare to help trim the budget," council spokesperson Kristin Walter told Becker's. "If Medicare oversight was improved, we could prevent the program from wasting more than $30 billion each year. Those funds could be used to bolster the budget and continue to provide healthcare services to seniors at current levels."

The council recommended CMS and lawmakers authorize a permanent Medicare prepayment claim review program to help ensure Medicare billing errors are identified before payment of claims.


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