According to the HHS Fiscal Year 2015 Agency Financial Report, improper home health claims rose due to new documentation requirements to support the necessity of services administered.
According to HHS, improper payments occur when federal funds go to the wrong recipient, the recipient receives the incorrect amount of funds, documentation is not available for a payment, or the recipient uses funds in an inappropriate manner.
Here are four findings on improper payment rates from the HHS report:
1. Medical necessity errors and insufficient documentation were among the chief causes of improper payments for home health claims in FY 2015.
2. The improper payment rate for home health claims was 58.95 percent in FY 2015, up from 51.38 percent in 2014.
3. The improper payment rate for skilled nursing facility claims rose from 6.94 percent in FY 2014 to 11.04 percent in FY 2015.
4. Overall, the Medicare fee-for-service improper payment rate was 12.09 percent in FY 2015.
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