2019 Medicare Fee-For-Service Improper Payment Rate is at its Lowest Since 2010

CMS announced that the Medicare Fee-For-Service (FFS) improper payment rate has fallen again, and is at its lowest level since FY 2010. CMS’ aggressive program integrity measures lowered the estimated amount of Medicare FFS improper payments $7 billion from FY 2017-2019 to a total of $28.9 billion.

This year’s decrease was driven largely by progress in these areas:

  • Home health claims corrective actions, including policy clarification and Targeted Probe and Educate for home health agencies, resulted in a significant $5.32 billion decrease in estimated improper payments from FY 2016 to FY 2019.
  • Other Medicare Part B services (e.g., physician office visits, ambulance services, lab tests, etc.) saw a $1.82 billion reduction in estimated improper payments in the last year due to clarification and simplification of documentation requirements for billing Medicare under our Patients Over Paperwork initiative.
  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies improper payments decreased an estimated $1.29 billion from FY 2016 to FY 2019 due to various corrective actions implemented over the years.

Despite the decrease in improper payments, don’t expect HHS and CMS to ease off with new regulations anytime soon. For more information, including updates on the first group of states to undergo the new PERM eligibility component, read the press release from CMS.