News: Medicare fee-for-service improper payments down $15 billion since 2016

CDI Strategies - Volume 14, Issue 52

Medicare fee-for-service (FFS) improper payments have declined by $15 billion since 2016, according to a report released by CMS.

The Medicare FFS estimated improper payment rate fell to 6.27% in fiscal year (FY) 2020, down from 7.25% in FY 2019, reported HealthLeaders Media. Skilled nursing facility claims experienced a $1 billion reduction in improper payments last year as the result of a policy change and other regulatory efforts taken by CMS.

This marked the fourth consecutive year where the Medicare FFS improper payment rate was below 10%, according to CMS. The decline was due in part to improvements in home health, including a $5.9 billion decrease in estimated improper payments from FY 2016 to FY 2020, reported HealthLeaders Media.

The agency also attributed the $15 billion reduction to efforts that identified the causes of improper payments, implemented action plans to correct them, and extended CMS' capacity to "address emerging areas of risk through work groups and interagency collaborations."

CMS' findings were released just over a month after the agency announced nearly a dozen new telehealth services would be included in Medicare FFS during the ongoing COVID-19 Public Health Emergency.

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