CMS plans to reduce Medicare payment errors

Healthcare Financial Management, Feb, 2005

The Medicare payment error rate is 9.3 percent for FY04, CMS recently announced, up from 5.8 percent in FY03, due in part to nonresponses from providers when errors were being resolved by contractors for insufficient documentation. CMS will attempt to reduce this rate by:

* Encouraging the American Medical Association (the owner of the physician coding system) to improve clinical examples and other documentation guidelines for correctly coding evaluation and management services

* Developing new data analysis procedures to identify payment aberrancies and using that information to stop improper payments before they occur

* Encouraging Medicare contractors to educate providers about documentation rules

* Encouraging Medicare contractors to educate providers about documentation rules

CMS will also expand the current FAQ database available on its web site. FAQs will be automatically generated from Medlearn Matters articles, and solicited from fiscal intermediaries, carriers, and more than 50 national associations.

To read the CMS error report, go to www. coverage.cms.fu.com/certpublic.

To strengthen your billing and coding practices, browse HFMA's revenue cycle resources at www.hfma.org/resource/pfs1.htm.