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7.3% Medicare Error Rate Puts Documentation Issues in Spotlight

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7.3% Medicare Error Rate Puts Documentation Issues in Spotlight

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Medicare claims

It can be unbelievably confusing to fill out your Medicare claims without making mistakes. But while errors are just a part of life in every other area, Medicare errors can be a different story. Auditors and reviewers are just waiting for you to put one wrong detail on your claims, allowing them to deny your charges, downcode your claims and even audit your practice.

In fact, CMS recently revealed a 7.38% error rate among fee-for-service Medicare claims, representing $31.2 billion in wrongly-submitted charges. Read on to find out a few of the problems auditors discovered.

Medicaid Errors Down Significantly

Although the Medicare error rate was about the same as last year, the Medicaid error rate was down quite a bit compared to last year’s numbers. CMS found that the Medicaid improper payment rate was 8.58% (representing $50.3 billion).

Although this error rate is higher than that of the errors among Medicare claims, it’s actually an improvement compared to last year, when the Medicaid error rate hit 15.62%.

Medicare Advantage Error Rate Holds Steady

When it comes to Medicare Part C (also referred to as Medicare Advantage), the error rate was 6.01%, representing $16.6 billion in incorrect payments. This rate is similar to the Part C error rate from the year before, demonstrating that providers may have paid closer attention to accuracy recently.

Insufficient Documentation a Continuing Theme

Among both Medicaid and Medicare claims, many of the improper payments were due to insufficient documentation. This means that the documentation the provider submitted to support their claims wasn’t adequate to justify the services they billed.

For instance: Suppose the provider submitted a claim for an E/M service and a lesion removal. The documentation discusses the lesion removal but does not mention any E/M service provided and doesn’t indicate how much time was spent on the E/M service. The MAC reviewer notes that the documentation was insufficient to support the E/M visit, and only pays the lesion removal.

Among Part C Medicare claims, CMS also found illegible documentation and missing documentation. This is a good reminder to ensure that all documentation is clear, valid and legible, and that you submit everything the payer requests, without missing any parts of the medical record.

Want to find out how to submit Medicare claims that are error-free? Let healthcare attorney Jody Erdfarb, JD help. During her 60-minute online training, Stop RAC Auditors From Taking Back Your Medicare Money, Jody will help you reduce Medicare errors and hang on to your pay. Register today!


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