Medicare FFS Improper Payment Rate Lowest Since 2010

Home > Articles > Medicare FFS Improper Payment Rate Lowest Since 2010

The Centers for Medicare & Medicaid Services (CMS) announced that the Medicare fee-for-service (FFS) improper payment rate is at its lowest level since fiscal year (FY) 2010. CMS says its program integrity measures lowered the estimated amount of FFS improper payments by $7 billion from FY 2017-2019 to $28.9 billion.

The estimated improper payment rate decreased to 7.25 percent in FY 2019, from 8.12 percent in FY 2018, the third consecutive year the improper payment rate has been below the 10 percent threshold for compliance established in the Improper Payments Elimination and Recovery Act of 2010.

CMS said this year's decrease was driven by progress in the following areas:

·        Home health claims corrective actions resulted in a significant $5.32 billion decrease in estimated improper payments from FY 2016 to FY 2019.

·        Other Medicare Part B services (e.g., physician office visits, ambulance services, lab tests, etc.) saw a $1.82 billion reduction in estimated improper payments in the last year due to clarification and simplification of documentation requirements for billing Medicare under the Patients Over Paperwork initiative.

·        Durable medical equipment, prosthetics, orthotics, and supplies improper payments decreased an estimated $1.29 billion from FY 2016 to FY 2019 due to various corrective actions implemented over the years.

"Our progress on improper payments is historic, but there's more work to be done," said CMS Administrator Seema Verma. "CMS has taken a multifaceted approach that includes provider enrollment and screening standards to keep bad actors out of the program, enforcement against bad actors, provider education on our rules and requirements, and advanced data analytics to stop improper payments before they happen. These initiatives strike an important balance between preventing improper payments and reducing the administrative burden on legitimate providers and suppliers."