Lack of documentation accounts for Medicare fee-for-service error rate

Share this content:

Medicare's fee-for-service error rate for fiscal 2010 would have fallen if compliance contractors had successfully obtained better claims documentation, a federal report found.

An investigation by Department of Health and Human Services Office of the Inspector General determined that the 2010 error rate accounted for an estimated $34 billion in improper payments. A 0.3% decrease would have lowered the improper payment amount by approximately $956 million.

An improper payment amount is the difference between the amount that Medicare paid a healthcare provider and the amount it should have paid. Contractors were working for the Centers for Medicare & Medicaid Services Comprehensive Error Rate Testing (CERT) program. While the OIG is sticking by a recommendation that would involve additional documentation on claims, the Centers for Medicare & Medicaid Services said it has already instituted policies that address these concerns.

Click here to read the full OIG report.