CMS reports lower claims error rate for 2008

Maybe having Recovery Audit Contractors in the news frequently has had some effect on provider claims practices. CMS has reported that the 2008 error rate for Medicare fee-for-service payments has decreased to 3.6 percent. Last year, improper payments for fee-for-service amounted to 3.9 percent of the total payments.

In one new wrinkle, the CMS also reported its first Medicare Advantage improper payment rate this year, of 10.6 percent. That amounted to $6.8 billion, in payments made in calendar year 2006. These errors came mostly from mistakes providers made in documenting members' diagnoses.

Also, the agency for the first time report the fiscal 2007 national composite error rates for Medicaid and the State Children's Health Insurance Program. The CMS reported $32.7 billion in improper payments to Medicaid, of which the federal share was $18.6 billion, and $1.2 billion to SCHIP, with a federal share of $800 million.

The CMS estimates that it has saved as much as $400 million over the last fiscal year. Officials emphasized that most of these errors are from incorrectly coded or medically unnecessary claims, not actual fraud.

To learn more about the figures CMS released:
- read this Modern Healthcare piece (reg. req.)

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