by Raquel Shumway
Jun 8th, 2022
The Medicare Improper Payment Report does not measure fraud, but 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, 2019 through June 30, 2020, was 93.74%, which is up slightly from last year. The estimated improper payment rate (claims paid incorrectly) was 6.26%, which is a slight decrease from the 2020 report.
Again, the biggest problem this year is the lack of documentation to support the services or supplies billed. This year the improper payments rate is 64.1%, which is up 4.6%. The following table from this report summarizes the problems by various categories and claim types.
Comparison of 2020 and 2021 National Improper Payment Rates by Error Category (Adjusted for Impact of A/B Rebilling)
|
2020 |
2021 |
|||||
| Error Category |
Total |
Total |
Part A Excluding Hospital IPPS |
Part A Hospital IPPS |
Part B |
DMEPOS |
| No Documentation |
0.3% |
0.3% |
0.1% |
0.0% |
0.1% |
0.0% |
| Insufficient Documentation |
4.0% |
4.0% |
1.9% |
0.2% |
1.4% |
0.5% |
| Medical Necessity |
1.0% |
0.8% |
0.5% |
0.3% |
0.1% |
0.0% |
| Incorrect Coding |
0.7% |
0.7% |
0.1% |
0.1% |
0.4% |
0.0% |
| Other |
0.3% |
0.4% |
0.3% |
0.0% |
0.1% |
0.1% |
| TOTAL |
6.3% |
6.3% |
2.9% |
0.6% |
2.1% |
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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