The Centers for Medicare & Medicaid Services (CMS) announced Monday it continues to see a major decrease in improper payments to providers, though not necessarily in the home health setting.
Specifically, the agency said that there has been a $20.72 billion reduction in Medicare fee-for-service improper payments since 2014.
“CMS is undertaking a concerted effort to address the root causes of improper payments in our programs,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “The continued reduction in Medicare fee-for-service improper payments represents considerable progress toward the Biden-Harris administration’s goal of protecting CMS programs’ sustainability for future generations. We intend to build on this success and take the lessons we’ve learned to ensure a high-level of integrity across all of our programs.”
While improper payments can be tied to fraud, waste or abuse, they are more likely due to insufficient documentation or other administrative mishaps.
“The primary reason for these errors is missing or insufficient documentation to support the certification of home health eligibility requirements,” CMS wrote in a coinciding improper payment report. “Medicare coverage of home health services requires physician certification of the beneficiary’s eligibility for the home health benefit.”
The home health improper payment estimate increased from 9.3% in 2020 to 10.24% in 2021, though CMS claims that this change is not statistically significant.
Overall, there was about $1.84 billion in improper payments dished out to home health providers this year, according to CMS.
The hospital outpatient setting received $3.41 billion in improper payments in 2021 — far more than any other provider type. Skilled nursing facilities (SNFs) received $2.67 billion in improper payments.
In order to combat improper payments, The U.S. Department of Health and Human Services (HHS) has “developed and refined” preventative and detective measures for specific service areas that have traditionally received them, including home health care.
In home health care, the Review Choice Demonstration (RCD) – which is now active in five states – is the latest example of these measures. Others include the elimination of home health Requests for Anticipated Payment (RAPs), which was introduced with the Patient-Driven Groupings Model, as well as the Targeted Probe and Educate (TPE) initiative.
“CMS is committed to reducing and preventing improper payments,” Jonathan Blum, the principal deputy administrator and COO for CMS, said in the announcement. “It is important to understand that only a small fraction of improper payments represent a payment that should not have been made – and an even smaller percentage represent actual cases of fraud.”
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