Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 22, 2010 PDF

If there was any question about whether the government's efforts to accurately account for improper Medicare payments was working, CMS has an answer. The error rate for Medicare claims declined in 2010, "and is on track for a 50 percent reduction by 2012," according to a Nov. 16 CMS news release. CMS changed the way it calculates the error rate for fee-forservice Medicare last year so the agency could more accurately reflect improper payments and help fight fraud and abuse, HHS Secretary Kathleen Sebelius said in a statement. "This year's lower rate reflects those changes and our focus on protecting Medicare," she said.

The 2010 Medicare and Medicaid improper payment rate was 10.5 percent (or $34.3 billion), compared to the 2009 error rate of 12.4 percent (or $35.4 billion).

The errors don't necessarily point to a confirmation of fraud, CMS notes in its statement. In fact, "the primary causes of errors in the Medicare FFS program for 2010 are insufficient documentation and medically unnecessary services," the agency indicates.