Improper Payment Rate for Home Health Jumps to More Than 58 Percent in FY 2015
Tuesday, November 24, 2015
by: Molly Smith, VP of Policy and Innovation

Section: Public Policy and Advocacy




Last week CMS released its "Fiscal Year 2015 Agency Financial Report." In the report, CMS notes that for FY 2015, the improper payment rate for home health claims was more than 58 percent. The FY 2015 rate is developed using claims from July 2013 – June 2014. The improper payment rate for home health claims in FY2014 was 51.4 percent. Both years represented the highest improper payment rate for home health services ever and, according to CMS, are “due to the documentation requirements to support the medical necessity of the services.” CMS identified three actions it is taking to reduce the improper payment rate for these services, including: (1) removing the physician narrative as part of the certification of patient eligibility for home health services as of Jan. 1, 2015, (2) creating voluntary draft paper and electronic clinical templates to help ordering physicians and ordering hospitals capture the information needed to certify that an individual is eligible for home health services, including documenting the F2F encounter, and (3) conducting pre-payment reviews of home health claims for episodes beginning on or after Aug. 1, 2015, using a Probe and Educate strategy.
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