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CMS reports decrease in improper payment rates

CMS reports decrease in improper payment rates

WASHINGTON – The improper payment rate for Medicare fee-for-service is 6.27% or $25.74 billion for fiscal year 2020 compared to 7.25% or $28.91 billion for fiscal year 2019, according to CMS. 

The decrease was driven by reductions in the improper payment rates for home health and skilled nursing facility claims, the agency says.  

Home health: There was a $5.90 billion decrease in estimated improper payments from 2016 to 2020 due to corrective actions such as policy clarification and Targeted Probe and Educate (TPE) programs for home health agencies. 

Skilled nursing facilities: There was a $1 billion decrease in estimated improper payments from 2019 to 2020 due to a policy change related to the supporting information for physician certification and recertification for skilled nursing facility services and TPE for skilled nursing facilities. 

CMS says improper payment rates are not necessarily indicative of, or measures of, fraud. Instead, they are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements and may be overpayments or underpayments. 

Additionally, CMS notes that improper payments do not necessarily represent expenses that should not have occurred.

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