Eli's Hospice Insider

Published on Wed Jan 15, 2020 PDF

Hospices not based in hospitals saw the error rate dip below 9% last year.

Medicare has just handed hospices ammunition to support their fight against being labeled as fraudsters.

The improper payment rate for fee-for-service Medicare hospice services in 2019 was 9.7 percent, says a newly released report from the Department of Health and Human Services. That’s down significantly from 11.7 percent for 2018.

The 9.7 percent rate represents $1.8 billion in erroneous payments to hospices last year, CMS notes in the report.

HHS breaks out the error rate for nonhospital-based hospices (8.9 percent compared to 11.0 percent in 2018) and hospital-based hospices (18.9 percent for 2019, down from 19.3 percent the year earlier).

Nonhospital-based hospices ranked fifth in the list of highest Part A improper payments at 5.1 percent, and hospital-based hospices ranked eighth at 1.0 percent.

Together, home health and hospices accounted for 14.7 percent of overall Medicare improper payments, according to the report.

States with the highest combined home health and hospice error rates in 2019 were Mississippi (22.4 percent) and Wisconsin (19.4 percent), HHS says.

In a statement released back in November, the Centers for Medicare & Medicaid Services cheered that the Medicare FFS improper payment rate overall “has fallen yet again, and is at its lowest level since FY 2010.”

The overall rate fell to 7.25 percent in 2019, from 8.12 percent in 2018, “the third consecutive year the Medicare FFS improper payment rate has been below the 10 percent threshold,” CMS touted. “Our aggressive program integrity measures lowered the estimated amount of Medicare FFS improper payments $7 billion from FY 2017-2019 to a total of $28.9 billion.”

Note: The 33-page report is at www.cms.gov/files/document/2019-medicare-fee-service-supplemental-improper-payment-data.pdf.