Medicare Improper Payment Report (2016)

by  Wyn Staheli, Director of Research
September 1st, 2017

The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2014 through June 30, 2015, was 89.0 percent. The estimated improper payment rate (claims paid incorrectly) was 11.0 percent which is a decrease from last years 12.1 percent rate.

As with most years, the biggest problem was the lack of documentation to support the services or supplies billed (64 percent of improper payments). It should be noted that although those numbers have decreased from last year, there is still room for improvement. The following table from this report summarizes the problems by various categories and claim types.

Table A2: Comparison of 2015 and 2016 National Improper Payment Rates by Error Category (Adjusted for Impact of A/B Rebilling)

 

2015

2016

       
Error Category

Total

Total

Part A Excluding Hospital IPPS

Part A Hospital IPPS

Part B

DMEPOS

No Documentation

0.2%

0.1%

0.0%

0.0%

0.1%

0.0%

Insufficient Documentation

8.1%

7.2%

4.2%

0.1%

2.0%

0.8%

Medical Necessity

2.1%

2.2%

1.4%

0.7%

0.1%

0.0%

Incorrect Coding

1.3%

1.1%

0.1%

0.3%

0.7%

0.0%

Other

0.4%

0.4%

0.1%

0.1%

0.0%

0.2%

TOTAL

12.1%

11.0%

5.9%

1.2%

2.9%

1.0%


To review information pertaining to your specialty, open the report found in the link in the "References" section below. It is a PDF file so you can search for information on your specialty by using [Ctrl]+[F] to look for key terms like DME or "Family Practice".

References:

Medicare Improper Payment Report (2016). (2017, September 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/medicare-improper-payment-report-2016-30257.html

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