by Jared Staheli, MPP
Oct 12th, 2020
The Medicare Improper Payment Report for 2019 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2017 through June 30, 2018, was 92.7%. The estimated improper payment rate (claims paid incorrectly) was 7.3%, which is a decrease of 0.8% from the 2018.
As with most years, the biggest problem was the lack of documentation to support the services or supplies billed (59.5% of improper payments). The following table from this report summarizes the problems by various categories and claim types.
Comparison of 2018 and 2019 National Improper Payment Rates by Error Category (Adjusted for Impact of A/B Rebilling)
|
2018 |
2019 |
|||||
| Error Category |
Total |
Total |
Part A Excluding Hospital IPPS |
Part A Hospital IPPS |
Part B |
DMEPOS |
| No Documentation |
0.2% |
0.1% |
0.0% |
0.0% |
0.1% |
0.0% |
| Insufficient Documentation |
4.7% |
4.3% |
2.2% |
0.3% |
1.3% |
0.5% |
| Medical Necessity |
1.7% |
1.4% |
0.7% |
0.6% |
0.1% |
0.0% |
| Incorrect Coding |
1.0% |
1.0% |
0.1% |
0.2% |
0.7% |
0.0% |
| Other |
0.5% |
0.4% |
0.3% |
0.0% |
0.0% |
0.1% |
| TOTAL |
8.1% |
7.3% |
3.3% |
1.1% |
2.2% |
0.6% |
To review information pertaining to your specialty, open the report found in the link in the "References" section below. It is a PDF file so you can search for information on your specialty by using [Ctrl]+[F] to look for key terms like DME or "Family Practice".
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