Medicare contractors denied payments for some valid services in 2010, according to an audit of improper payment determinations by a government watchdog and an American Medical News report.
CMS uses contractors to manage an error-rate testing program that calculates the frequency of improper payments in Medicare fee-for-service. A review of 2010 audits found that the reported 10.5 percent error rate would have been lower if contractors had taken extra steps to get records showing that billed services were medically necessary.
According to the report, the OIG said that additional efforts to obtain missing documentation would paint a better picture of the true status of improper payments. With this extra effort, the error rate in 2010 would have been 10.2 percent, nearly $1 billion less in improper payments.
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CMS uses contractors to manage an error-rate testing program that calculates the frequency of improper payments in Medicare fee-for-service. A review of 2010 audits found that the reported 10.5 percent error rate would have been lower if contractors had taken extra steps to get records showing that billed services were medically necessary.
According to the report, the OIG said that additional efforts to obtain missing documentation would paint a better picture of the true status of improper payments. With this extra effort, the error rate in 2010 would have been 10.2 percent, nearly $1 billion less in improper payments.
Related Articles on Coding, Billing and Collections:
CMS to Begin Immediate Recoupment for Overpayment
Top 1% of Insured People Under 65 Account for Top 25% of Healthcare Costs
Oklahoma Health Exchange Proposal Would Violate Requirement to Connect With Federal Subsidies