Medicare’s process of Measuring Payment Errors afflicted with problems

It has been reported in the American Association for Homecare in this week’s Mobility Matters publication that the U.S. Department of Health and Human Services (HHS) has exposed severe defects in the methodology employed to measure the error rate on payments for services and products provided to Medicare Plan patients.

In a recent study the HHS Office of Inspector General (OIG) concluded that inappropriate fee-for-service Medicare payments reported to Congress for financial years 2009 and 2010 should have been decreased by about $2 billion each year. The difference is owing to thousands of denied claims mentioned as inappropriate payments that were later upturned and paid during the appeals process.

The Comprehensive Error Rate Testing (CERT) program, which evaluates annually the Medicare advantage plans error rate on payments, examines the frequency at which the Centers for Medicare and Medicaid Services (CMS) rejects payments to hospitals and providers because it found out that appropriate  reimbursement and coverage measures were not used. The government concedes that CERT was planned to evaluate Medicare Plan billing errors and not fraud or abuse.

The OIG study is important because the finding underlines the amount of the errors in the CMS reimbursement and documentation policies according to Mobility Matters article. In the present procedure CMS is refuting reimbursement claims for home medical health care equipment like oxygen therapy, hospital beds, and power wheelchairs, unless certain guidelines are met.

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