CMS claims submissions getting cleaner

Driven by efforts in which it analyzes data and targets areas of potential waste, fraud and abuse, CMS has managed to cut the number of improper Medicare claims on the one billion per year it receives from 4.4 percent in 2006 to 3.9 percent in 2007. That's big progress, particularly when you consider that the rate of improper claims filed stood at 14.2 percent in 1996. Due to the improvement in claims filings, Medicare's fee-for-service program paid $11 billion less in incorrect payments, according to the agency.

Having made such progress in Medicare, CMS has also begun looking at payment error rates for Medicaid, focusing for starters on 17 states. During its current measurement period, the first year it had attempted Medicaid monitoring, the rate of improper payments was 18.5 percent. The high error rate sprung from claims with inadequate supporting documentation, the agency says. It now plans to work with the states to put a program in place similar to what it has with Medicare.

To learn more about the error measurement programs:
- read this Modern Healthcare piece

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