“The vast majority of Medicaid errors are due to inadequate documentation…” – CMS
The above statement comes directly from a Fact Sheet just posted on the CMS website. (Find the sheet here.) Candidly, we know this is not really NEW. It is a rather aged refrain. Nevertheless, we think it stands reporting/repeating, because it does seem to keep coming up, and this is just the latest, most public declaration of what is really at issue, and further substantiates what was even reported during the RAC Demonstration Project.
What is “news” is this statement in the Fact Sheet:
“Based on recommendations from the HHS Office of the Inspector General (OIG), Members of Congress and CMS clinical experts, the Agency modified the FFS medical review process used to identify improper payments this year.“
There is no explanation of what or how they changed the review process, but the results are quite impressive:
“As a result of this heightened scrutiny and more complete accounting of Medicare FFS claims, CMS is reporting a 2009 FFS error rate of 7.8 percent, or $24.1 billion, compared to 3.6 percent in 2008.“
The calculated error rate more than doubled, between 2008 and 2009. One can readily deduce that the changes, whatever they are, are significant.
The changes are neither listed nor detailed, but CMS does state that it is “taking further steps” to insure the following:
- that providers are submitting all required clinical and medical documents to support a claim,
- that providers’ signatures on medical documents are legible,
- that a provider’s claims history can no longer be used to fill in missing treatment documentation, and
- will require that medical information from a provider be included to support DME claims, in addition to the already required records from suppliers.
All of those steps are significant. While CMS again neither mentions nor details what these “further steps” are, it behooves a provider to pay attention to what they have outlined as their intended targets — namely, the four bullets, above.
It is also interesting to note that while much of the industry is focused on what the RACs are doing, the RACs were not even mentioned in this report, but HEAT was directly named. If you are not aware of HEAT, you should see our previous post about them.
See our news article about CMS’ Press Release and the Fact Sheet, here.
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