Regulations

CMS released the Medicare fee for service improper payments report for 2013

The estimated 2013 Medicare FFS improper payment rate – the percentage of Medicare dollars paid incorrectly – was 10.1 percent. This means that Medicare paid an estimated $36.0 billion incorrectly between July 2011 and June 2012. For 2013, CMS adjusted the improper payment rate by 0.6 percent ($2.2 billion) from 10.7 percent to 10.1 percent to account for the effect of rebilling inpatient hospital claims denied under Medicare Part A.

The SNF inpatient improper payment rate increased from 4.8% during the 2012 reporting period to 7.7% during the 2013 reporting period. The projected improper payment amount for SNF services during the 2013 report period was $2.6 billion.

The majority of improper payments for SNF services were due to insufficient documentation. Providers of SNF services are required to submit medical records to support the medical necessity of SNF services provided. For example, required documents may include:

  • A certification that the beneficiary needed daily skilled care that could only be provided in a SNF setting;
  • A plan of care; and
  • The time (in minutes) for each therapy service provided