WASHINGTON - The Centers for Medicare & Medicaid Services is continuing to reduce erroneous payments for Medicare services, although it's still struggling to overcome insufficient documentation errors, the most common reason for overpayments.
"The decline in improper payments reflects our emphasis on identifying and eliminating waste, fraud and abuse in all CMS programs," said CMS Acting Administrator Kerry Weems. "It is critical that we ensure every dollar is spent wisely so that the program is affordable for taxpayers and future generations of beneficiaries."
According to reports, the Medicare fee-for-service error rate declined to 3.9 percent in 2007. That's down from 14.2 percent in 1996, when CMS first started reporting the Medicare improper payment rate. During the past three years, reductions in erroneous payments have resulted in $11 billion in savings, the agency reported. CMS pays more than 1 billion fee-for-service claims each year.
CMS has been able to identify where problems exist and target improvement efforts by looking at detailed reviews of randomly sampled Medicare claims submitted between April 1, 2006 and March 31, 2007, including about 140,000 claims spanning all types of Medicare fee-for-service payments.
Research shows that the majority of the preliminary Medicaid fee-for-service error rate is a result of insufficient documentation, meaning that all of the supporting information necessary to verify the accuracy of the claim was not provided. CMS contends that if its payment contractors had If all claims had sufficient supporting documentation, contractors handling claims could have better determined whether a payment was appropriate.
"The agency has proven that when it spends time to make sure those given Medicare provider numbers are really who they say they are, tax dollars are safeguarded and there's more money left for beneficiaries," said Sen. Chuck Grassley (R-Iowa), who's been critical of the agency in past years. "The positive results should encourage more of the same so that further gains can be made."
CMS details its Medicare improper payment findings in an annual report released every November. The complete report contains additional error rate information along with more specific improper payment estimates. After it's completed, the report will be posted at www.cms.hhs.gov/cert.