Awareness : Newsletter Articles

The Projected Improper Payment Amount for Outpatient Services for 2017 Period Was $1.9 Billion

The Medicare Fee-For-Service (FFS) improper payment rate for hospital outpatient services was 3.2 percent, accounting for 5.2 percent of the overall Medicare FFS improper payment rate in 2017. The projected improper payment amount for outpatient services during the 2017 report period was $1.91 billion.

To prevent denials for outpatient services

The following documentation is required for hospital outpatient services to be covered under the Medicare health benefit:

  1. Documentation that supports medical necessity of the outpatient service (e.g. physician’s office visit note, or progress note, etc.)
  2. A signed and dated physician’s order for the outpatient service
  3. Documentation showing that the service was rendered Signatures may be handwritten, electronic.  Stamped signatures are only permitted in the case of an author with a physical disability who can provide proof to a CMS contractor of an inability to sign due to a disability

Resource:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports-Items/2017-Medicare-FFS-Payment-Data.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending