CMS: Home Health Improper Payments Down by $5.9B Since 2016

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Home health providers continue to make serious progress in reducing improper payments under fee-for-service Medicare, the U.S. Centers for Medicare & Medicaid Services (CMS) announced Monday.

Since 2016, improper payments to home health providers have dropped by an estimated $5.9 billion, according to CMS. All improper payments in fee-for-service Medicare are down by an estimated $15 billion compared to four years ago.

“From the beginning, this administration has doubled down on our commitment to protect taxpayer dollars,” CMS Administrator Seema Verma said in a statement. “This year’s continued reduction in Medicare improper payments is a direct result of those actions.”

The government has paid out an estimated $25.74 billion in Medicare fee-for-service improper payments in 2020, with an overall improper payment rate of 6.27%. Last year, the government paid out $28.91 billion in estimated improper payments, with a rate of 7.25%.

Source: CMS

Improper payments are occasionally tied to fraud, waste and abuse, but that’s not always the case. Improper payments are often payments that simply did not meet certain regulatory or administrative requirements, perhaps due to unintentional documentation mishaps.

Additionally, improper payments do not necessarily represent expenses that should not have occurred, according to CMS.

CMS attributed to this year’s decrease in improper payments to the ongoing corrective actions it has taken over the years. The agency’s Review Choice Demonstration (RCD) is one example of those actions specific to home healthy care.

“Health care costs are skyrocketing; by 2026, one out of every five tax dollars will be spent on health care,” CMS noted in its Monday announcement. “To constrain unsustainable cost growth, CMS must continue to ensure payments are made according to the rules.”

On top of CMS actions, the home health industry has worked diligently over the past several years to police itself and weed out bad actors. The hard look in the mirror has helped the industry slash its improper payment rate drastically compared to 2015, when it checked in at an astronomical 58.95%.

“The value of home care is well established with proven cost savings, better outcomes and innovations in patient care being demonstrated every day,” Amedisys Inc. CEO and President Paul Kusserow wrote to Home Health Care News in April 2019. “We look forward to working with CMS and others to ensure the rate of improper payments continues to decline.”

Source: CMS

Improper payments to skilled nursing facilities (SNFs) are also down in 2020.

Specifically, SNFs saw a $1 billion reduction in estimated improper payments in the last year, according to CMS. The agency said the reduction is largely due to a policy change related to the supporting information for physician certification and recertification for SNF services, as well as CMS’s Targeted Probe and Educate efforts.

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