Eli's Hospice Insider

Published on Tue Dec 18, 2018 PDF

 But Medicare’s improper pay rate for hospices has fallen significantly.

Hospices looking for relief from regulatory and medical review burdens may have a good argument, thanks to new payment error figures.

In a new Comprehensive Error Rate Testing report released by the Department of Health & Human Services, HHS pegs the Medicare payment error rate for hospices at 11.7 percent for 2018, which covers claims processed between July 1, 2016, and June 30, 2017.

That’s down 3 percentage points from last year’s rate, notes the National Association for Home Care & Hospice in its member newsletter.

The report breaks out the error rate into hospital and nonhospital-based hospice claims, recording a 19.3 percent improper payment rate for hospital-based claims and 11.0 percent for nonhospital-based claims.

Other stats released in the report include:

• The 11.7 percent rate represents 6.4 percent of Medicare’s overall improper payments.
• The CERT contractor reviewed 920 hospice claims — 766 nonhospital-based and 154 hospital-based.
• Insufficient documentation was the reason for 62.2 percent of improper hospice payments.
• Medical necessity accounted for 24.7 percent of improper payments; incorrect coding 10.4 percent; no documentation 4.6 percent; and “other” 0.2 percent.
• Hospice claims had the highest upcoding error rates among the provider types listed at 2.7 percent for hospital-based and 1.1 percent for nonhospital-based. The next-closest provider type was Skilled Nursing Facility Inpatient Part B at 0.4 percent.
• Hospice claims had a 0 percent underpayment rate.
• Hospital-based hospices had the highest claims found in error rate of all provider types listed at 27.3 percent. Nonhospital-based hospices had the fifth-highest rate out of 11 provider types at 15.7 percent.
• A hospice claims error ranked in the top 5 root causes of insufficient documentation errors for Medicare claims — “Hospice certification/recertifi­cation requirements, in entirety or an element, was not submitted” affected 54 claims.