Health Information Management

News: CMS report finds reduction in improper hospital claims

CDI Strategies, November 24, 2015

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Hospitals are reporting a decrease in improper payments, according to the U.S. Department of Health and Human Services (HHS) annual Agency Financial Report.

The report highlights updates on the improper payment rates for several CMS programs for fiscal year (FY) 2015, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). In addition to the decrease in improper payments, the report shows a corresponding increase in correct coding as well as correct and complete supporting documentation for services provided, according to CMS.

However, some areas showed slight increases in improper payments. Medicaid improper payment rates increased from 6.7% in FY 2014 to 9.8% in FY 2015. Improper CHIP payment rates increased from 6.5% to 6.8%. Medicaid Part D improper payment rates saw a 0.3% increase in FY 2015. CMS attributes these increases to new provider enrollment and screening requirements from the Affordable Care Act and HIPAA. The new requirements will strengthen Medicaid and CHIP programs and lead to improper payment rate decreases in the coming fiscal year, says CMS.

Editor’s Note: This article was originally published in HIM-HIPAA Insider. Click here to read more.

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