CMS Says Improper Medicare Fee-for-Service Payments Are Down $15 Billion Since 2016
CMS is claiming that its “aggressive corrective actions” have saved taxpayers over $15 billion in improper Medicare Fee-For-Service (FFS) payments over the past four years. According to the November 16 report, the FFS improper payment rate has significantly declined under the Trump administration and has been below 10 percent for four straight years since 2016. Home Health and SNF Initiatives Drive Savings According to the CMS report, the FY 2020 Medicare FFS improper payment rate was 6.27 percent, representing $25.74 billion in improper payments, as compared to a rate of 7.25 percent accounting for $28.91 billion improper payments in FY 2019, and marking the fourth straight year the rate has been below the 10 percent threshold mandated by the Payment Integrity Information Act of 2019. CMS cites progress in the following areas as the principle driver of this year’s decline in Parts A and Part B: Home health improvements: Initiatives to clarify documentation requirements and educating providers via the Targeted Probe and Educate program resulted in a $5.9 billion decrease in estimated improper payments from FY 2016 to FY 2020; and Skilled nursing facility claims: A policy change related to the supporting information for physician certification and recertification for skilled […]
- Home health improvements: Initiatives to clarify documentation requirements and educating providers via the Targeted Probe and Educate program resulted in a $5.9 billion decrease in estimated improper payments from FY 2016 to FY 2020; and
- Skilled nursing facility claims: A policy change related to the supporting information for physician certification and recertification for skilled nursing facility services helped drive a $1 billion reduction in estimated improper payments in the last year.
- Stop the Bad Guys
- Prevent Fraud Before It Happens
- Mitigate Emerging Programmatic Risks
- Emphasize the Carrot Over the Stick
- Leverage New Technology
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