CMS is seeing progress toward its goal of cutting the Medicare fee-for-service error rate in half by 2012, according to a CMS official's testimony before Congress.
Deborah Taylor, CFO and director of the agency's Office of Financial Management, said the error rate had fallen by 1.9 percentage points from FY 2009 to FY 2010, moving closer to the goal of cutting the error rate from 12.4 percent to 6.2 percent by 2012.
Ms. Taylor was testifying on March 17 with HHS Inspector General Daniel R. Levinson before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.
Mr. Levinson reported that only 2 percent of improper payments are the result of fraud. Citing the 2009 Comprehensive Error Rate Testing program, the latest available year, he said, "Insufficient documentation, miscoded claims and medically unnecessary services and supplies accounted for 98 percent of the improper payments."
Developing new methods to avoid claims errors
Mr. Levinson and Ms. Taylor said their offices are collaborating on developing new ways to detect and stop payment on claims errors. "We recommended that CMS take several actions to address these errors, including improving controls, educating providers and clarifying guidance," Mr. Levinson said.
For the 1.2 billion claims CMS expects to process in 2011, Ms. Taylor said the agency has installed automated safeguards that could detect and reject payments for "medical services that are physically impossible, such as a hysterectomy billed for a male beneficiary." However, "some vulnerabilities cannot be fixed with automated edits and may require ongoing medical review and other more resource intensive activities," she said.
She noted Congress has been asked to allow CMS to retain some of the funds recouped by recovery audit contractors to implement additional corrective actions, such as targeted prepayment review and provider education. This change could achieve net savings of $230 million over 10 years, she said.
Read Ms. Taylor's testimony on claims errors (pdf).
Read more coverage of Medicare claims errors:
- GAO Study Outlines Key Strategies to Reduce Fraud in Medicare, Medicaid
- Medicare Carrier Finds 50-90% Error Rate for E/M Codes
- RACs and Medicare Administrative Contractors to Work Together
Deborah Taylor, CFO and director of the agency's Office of Financial Management, said the error rate had fallen by 1.9 percentage points from FY 2009 to FY 2010, moving closer to the goal of cutting the error rate from 12.4 percent to 6.2 percent by 2012.
Ms. Taylor was testifying on March 17 with HHS Inspector General Daniel R. Levinson before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.
Mr. Levinson reported that only 2 percent of improper payments are the result of fraud. Citing the 2009 Comprehensive Error Rate Testing program, the latest available year, he said, "Insufficient documentation, miscoded claims and medically unnecessary services and supplies accounted for 98 percent of the improper payments."
Developing new methods to avoid claims errors
Mr. Levinson and Ms. Taylor said their offices are collaborating on developing new ways to detect and stop payment on claims errors. "We recommended that CMS take several actions to address these errors, including improving controls, educating providers and clarifying guidance," Mr. Levinson said.
For the 1.2 billion claims CMS expects to process in 2011, Ms. Taylor said the agency has installed automated safeguards that could detect and reject payments for "medical services that are physically impossible, such as a hysterectomy billed for a male beneficiary." However, "some vulnerabilities cannot be fixed with automated edits and may require ongoing medical review and other more resource intensive activities," she said.
She noted Congress has been asked to allow CMS to retain some of the funds recouped by recovery audit contractors to implement additional corrective actions, such as targeted prepayment review and provider education. This change could achieve net savings of $230 million over 10 years, she said.
Read Ms. Taylor's testimony on claims errors (pdf).
Read more coverage of Medicare claims errors:
- GAO Study Outlines Key Strategies to Reduce Fraud in Medicare, Medicaid
- Medicare Carrier Finds 50-90% Error Rate for E/M Codes
- RACs and Medicare Administrative Contractors to Work Together