News: Insufficient documentation causes vast majority of improper payments, HHS says

In 2022, insufficient documentation caused approximately 91% of improper payments by CMS, according to a report released by the United States Department of Health & Human Services (HHS).

HHS’ new report, entitled 2022 Medicare Fee-for-Service Supplemental Improper Payment Data, found that, for the year 2022, CMS paid $31.46 billion total in improper payments.

The authors of the report noted that, of the $31.46 billion,

• 63.6% was caused by insufficient documentation
• 13.8% was due to errors in medical necessity
• 10.5% was due to incorrect coding; 8.3%, was due to “other”
• 3.8% was due to no documentation whatsoever

Nevertheless, in all the three types of facilities HHS examined—e.g., skilled nursing facilities, hospital outpatient, hospice and home health—“insufficient documentation” configured into each of the top five causes for improper payments.

Editor’s note: To read the HHS report, click here.