HHS revises Medicare fee-for-service error rates

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The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have significantly revised its calculations of Medicare fee-for-service (FFS) error rates in 2009.

Reflecting different accounting of Medicare’s improper payments than in past years, the agencies said that these changes will provide CMS with more complete information about errors so that it can better target improper payments.

The Medicare, Medicaid and Children’s Health Insurance Program improper payment rates are issued annually as part of the HHS Agency Financial Report.

While improper payment rates are not necessarily an indicator of fraud in Medicare or any other federal health care program, according to the agencies, they do provide HHS, CMS and their partners who are responsible for the oversight of Medicare and Medicaid funds an assessment of how many errors need to be fixed.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said acting CMS administrator Charlene Frizzera.  “We hope to be able to use data available through the use of new EHR reporting that can help in the design of new and innovative approaches to finding emerging trends and vulnerabilities in high risk areas such as durable medical equipment and home health.”

Frizzera also pointed out the HHS and the CMS would invest more time and resources into working with providers to eliminate errors through increased and improved training and education outreach.