Medicare Compliance & Reimbursement

Usual suspects impact the overall numbers.

Error rate benchmarking is tricky. Larger states naturally add more to the overall improper payment amounts because of their Medicare population while smaller states sometimes lack resources and register higher error rates on the claims the feds sample.

Refresher: In CMS’ latest CERT breakdown, the “2021 Medicare Fee-for-Service Supplemental Improper Payment Data,” which went live on December 7, the agency offers insight into each state’s error rate data. The top three states with the biggest overall impact to the improper payment rate in 2021 are the same as those in 2020: California at 11.9 percent, Texas at 10.1 percent, and Florida at 6.7 percent.

Interestingly, some of the smaller states and territories logged the highest error rates in 2021. Check out this chart with the top five states with the highest error rates and the five with the highest amount of improper payments.

States/Territories With the Highest Projected Improper Payment Rates

States/Territories With the Highest Projected Improper Payment Amounts (dollars in millions)

Source: Data from Table B8 of the 2021 Medicare Fee-for-Service Supplemental Improper Payment Data www.cms.gov/files/document/2021-medicare-fee-service-supplemental-improper-payment-data.pdf-0.