OIG Announces National Medicare Error Rate Estimates
In January, the Medicare Inspector General issued its report entitled “Improper Fiscal Year 2002 Medicare Fee-for-Service Payments.” OIG estimates that improper FY 2002 Medicare national benefit payments totaled $13.3 billion or six percent of the $212.7 billion total Medicare fee for service payments.
Improper payments nationally were broken down into three major categories as follows:
1. Documentation Errors (28.6 % of errors) – insufficient documentation to determine the patient's overall condition, diagnosis and extent of services performed. OIG commented that in many cases, it was clear that services were provided but the physician’s order, or documentation of the patients medical condition, was missing.
2. Medically unnecessary services (57% of errors) - sufficient information in the medical record for review staff to make informed decisions that the service did not meet Medicare’s definition of medical necessity.
3. Coding errors (14.3% of errors) – documentation supported a lower code level.
OIG advised Medicare in this report that
“… continued vigilance is needed to ensure that providers maintain adequate documentation supporting billed services, bill only for services that are medically necessary, and properly code claims.” They also noted that “these problems have persisted for the past seven years.”
This report represents the last time the OIG will take on this audit role. In the future, Medicare will use newly developed computer programs to publish national error rates and develop baseline error rates for local contractors that identify specific provider billing anomalies in the region. Contractors then will develop targeted corrective action plans to reduce payment errors through provider education, claim reviews and other activities and Medicare will evaluate providers rate of improvement.
All practices are encouraged to review this report
in its entirety at (http://oig.hhs.gov/oas/reports/cms/ 170202202.pdf). Continued awareness of the documentation requirements, especially for the codes identified above, is key to BWH’s success in complying with Medicare rules and regulations.
Questions about this report
Or the need for additional assistance with documentation and coding, should be directed to your department compliance staff or Neil Walsh at 617-732-9377.