Medicare Error Rate Falling

01 Apr

CMS, or the Centers for Medicare & Medicaid Services, set a goal to cut the Medicare fee-for-service error rate in half by 2012. According to a CMS official’s testimony in front of Congress, they are seeing progress towards that goal.

According to Deborah Taylor, CFO and director of the CMS’s Office of Financial Management, the error rate fell by nearly two percent from FY 2009 to FY 2010. Their goal is to cut the error rate from 12.4 percent to 6.2 percent by 2012.

Taylor testified alongside Health & Human Services Inspector General Daniel R. Levinson in front of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies on March 17.

"We recommended that CMS take several actions to address these errors, including improving controls, educating providers and clarifying guidance," said Mr. Levinson in regards to the collaboration between CMS and HHS on developing methods of detecting and stopping payment on claims errors.

Ms. Taylor said the agency has installed automated safeguards for this year that could detect and reject payments for "medical services that are physically impossible, such as a hysterectomy billed for a male beneficiary."

She does caution that some errors can’t be corrected through automated means and that they need to be further reviewed and be susceptible to other means of correction.

The Centers for Medicare & Medicaid Services expects to process 1.2 billion Medicare claims in 2011.

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Posted in Medicare