What’s happening: Two recently issued reports highlight Medicare paid claim error rates in the fee-for-service (FFS) program for fiscal year 2024.

• AHCA/NCAL believes that there will be increased Medicare contractor claim review activity until the skilled nursing facility (SNF) paid claims error rate returns to lower levels.
• Errors can be corrected by improving documentation, MDS and claim coding, and triple-checking other similar pre-MDS submission and pre-claim submission compliance activities.

About the two reports:

1. The U.S. Department of Health and Human Services published the Fiscal Year 2024 HHS Agency Financial Report. It highlights the Medicare FFS paid claims error rates for Part A and Part B services for October 2023 through September 2024. During FY 2024, Medicare paid an estimated 92.34 percent of total Part A and Part B outlays for all providers properly, totaling $382.02 billion. The estimated improper payment rate across all providers was 7.66 percent, or $31.70 billion. In contrast, the estimated improper payment rate for SNF claims increased from 13.76 percent in FY 2023 to 17.2 percent in FY 2024.
2. CMS published the 2024 Medicare FFS Supplemental Improper Payment Data report, which includes root causes of SNF Medicare Part A claim errors. It highlights that most errors are not related to medical necessity but are due to various correctable documentation and signature errors.

How to minimize Medicare claim payment errors and audit risk: AHCA/NCAL offers resources to assist, including ahcancalED and the AHCA/NCAL Associate Business Member (ABM) Directory for coding, documentation, billing, and compliance expert consultant partners of AHCA/NCAL.

CMS also offers resources, including:

• The SNF Billing Reference Educational Tool,
• SNF 3-Day Rule Billing, and
• MDS RAI Manual.

Please contact AHCA/NCAL’s Dan Ciolek with questions.