Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

DC Tops Medicare List for Wasteful Healthcare Spending

It was found that the District of Columbia had the largest amount of waste per consumer throughout the country with nearly $178 wasted per individual.

By Vera Gruessner

- When it comes to medical care reimbursement, one of the most pivotal issues is eliminating wasteful healthcare spending. The Council for Medicare Integrity released a report detailing wasteful healthcare spending throughout the Medicare fee-for-service program.

Wasteful Medicare Spending

In particular, the analysis measures how much money was wasted per beneficiary. It was found that the District of Columbia had the largest amount of waste per consumer throughout the country with nearly $178 wasted per individual.

This type of finding is important to address, as Washington D.C. actually includes the smallest number of Medicare beneficiaries throughout all 50 states, according to records from the Centers for Medicare & Medicaid Services (CMS).

“Medicare loses more money to waste than any other Federal program. According to FY2014 Comprehensive Error Rate Testing (CERT) conducted by CMS, the Medicare FFS program has a 12.7 percent billing error rate,” the report stated.

  • 70% of Providers See Data Sharing as Key to Value-Based Care
  • Top 3 Ways Accountable Care Organizations Could Garner Savings
  • 3 Policy Challenges Health Insurance Exchanges Face
  • Employers Seek Clarity, Stability in Health Insurance Market
  • AHIP Sees 28% Increase in Medigap Enrollment Among Seniors
  • Affordable Care Act, Accountable Care Display Success
  • GAO: Medicare DME Prior Authorization Programs are Effective
  • How Value-Based Care Payment Models Could Reduce Costs
  • Out-Of-Pocket Healthcare Spending on the Decline Since 2000
  • Health Insurance Marketplace Cuts Costs, CMS Boosts Quality
  • Humana Bold Goal Targets Members’ Social Determinants of Health
  • Private Payers Follow CMS Lead, Adopt Value-Based Care Payment
  • Health Insurance Exchanges Require Engagement, Narrow Networks
  • 70% of Uninsured Texans Find Medical Coverage Costs too High
  • Payers Benefit from Aligning with MIPS, Value-Based Care
  • 6.4 Million Enrollees Sign Up on Affordable Care Act Exchanges
  • Lawmakers Propose HDHP Coverage for Chronic Disease Prevention
  • Trial Date Set for Aetna-Humana Health Insurance Merger
  • Healthcare Payers’ Top 5 Areas of Advancement, Opportunity
  • Explaining Out-of-Pocket Costs May Ease Cancer Care Stress
  • Health Information Technology Allows Payers to Share Data
  • Michigan MSSP Accountable Care Org Saves $8M for Medicare
  • Patients with Pre-Existing Conditions Need Affordable Care Act
  • Health Insurance Marketplaces Call for Plan Standardization
  • Narrow Insurance Networks Can Limit Options for Cancer Care
  • Balance Billing Hits Patients with Surprise Healthcare Costs
  • Why GOP Should Hold Off on Replacing the Affordable Care Act
  • UnitedHealthcare Adopts Bundled Payment Model for Surgeries
  • Former CMS Employee Found Guilty in Insider Trading Scheme
  • 49M Americans Risk Losing Fixed Indemnity Health Insurance
  • Why Aetna, Humana Argue in Favor of Health Insurance Merger
  • Low Medicaid Payment Rates Decrease Residential Care Quality
  • House Reps Add Amendments to the American Health Care Act
  • Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”
  • The Role ACOs Play in Propelling Population Health Management
  • Senate to Vote on Funding CHIP for Five Additional Years
  • Assessing Providers for Participation in Value-Based Care Contracts
  • How Physician Home Care Lowers ER Visits and Healthcare Costs
  • Clinical Data Analytics Key for Value-Based Care Reimbursement
  • Do Provider Reimbursement Pathways Need Oncologist Perspective?
  • What the Health Insurance Marketplace Should Expect in 2016
  • Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers
  • Insurance Coverage Grows as Consumers Explore Payer Options
  • How to Design and Support an Accountable Care Organization
  • End-of-Life Counseling Sessions Stall despite Medicare Payment
  • Social Determinant Data Key to Successful Risk-Based Contracts
  • Physician Leadership Key to Accountable Care Organizations
  • Accountable Care Organizations May Improve Diabetes Management
  • GAO: Medicaid Home, Community Care Create Financial Conflicts
  • Why Value-Based Care Reimbursement, MACRA are Here to Stay
  • Care Coordination Vital in Accountable Care Organizations
  • NY Senate Considers Proposal for Single Payer Healthcare
  • Veterans Gained Coverage under ACA, but May Lose Big from Repeal
  • Health Insurance Mergers May Harm Consumer Interests
  • Tavenner Steps Down from AHIP, Hands Leadership to Matt Eyles
  • Federal Judge Strikes Down Cigna-Anthem Health Insurance Merger
  • How Care Management Strategies Could Reduce Medical Costs
  • CMS Releases Final Rule for Medicare Physician Fee Schedule
  • Data Sharing Among Payers Advances Population Health Management
  • 23% of Voters Find Affordable Care Act ‘Extremely Important’
  • Rise in High-Deductible Health Plans Requires Cost Transparency
  • How Provider Portals Streamline Medical Claims Management
  • HHS Approves Alaska 1332 Waiver for State Reinsurance Program
  • Competitive Bidding Curbs Medicare Durable Medical Equipment Costs
  • Affordable Care Act Changes May Bring a Rocky 2018 for Payers
  • Medicare Diabetes Prevention Program Saves $2,650 per Patient
  • Blue Shield, Accountable Care Organization Saved $325 Million
  • Healthcare Payers Face Challenges with Medical Loss Ratio
  • Medicaid Managed Care Spending Rose to $107 Billion in 2014
  • URAC Stresses Accreditation in Medicare Physician Fee Schedule
  • CMS Rule Renovates Coverage beyond ACA’s Medicaid Expansion
  • Anthem Adds Home Meal Delivery to Medicare Advantage Plans
  • Governors Propose Health Insurance Market Stabilization Plan
  • Why State Medicaid Expansion May be Worthwhile for All
  • Do Beneficiary Incentive Programs Cut Costs, Prevent Disease?
  • ACA Health Insurance Exchanges Bring Challenges for 2017
  • Consumers Voice Opinions on Effective Healthcare Marketing
  • Payers Express Enthusiasm for Prescription Drug Pricing Reforms
  • High-Deductible Health Plans Reduce Care Costs, Needed Services
  • Ridesharing Benefit May Help Payers Improve Patient Engagement
  • CMS Approves Medicaid Work Requirements in New Hampshire
  • Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015
  • Aetna to Waive Narcan Co-Pays, Combat Opioid Overprescribing
  • CMS Bundled Payment Models Lead to Greater Patient Selectivity
  • Pediatric Data Reveals Private Payer, Medicaid Spending Gaps
  • Sanders’ Universal Healthcare Coverage May Have Pitfalls
  • CMS Outlines Special Enrollment Period Rules for ACA Exchanges
  • Will Health Insurance Mergers Stifle Market Competition?
  • Commercial Payer Prices Outpace Medicare, Medicare Advantage
  • Humana Becomes Latest Payer to End AHIP Membership
  • MACRA Implementation Solutions Payers, Providers Should Follow
  • CMS Bundled Payment Models Cut $864 for Orthopedic Care Episode
  • How to Create a Useful Contract for Bundled Payment System
  • Do Medicare Part B Prescription Drug Changes Hurt Rural Hospitals?
  • How the ACA Increased Enrollment in Medicaid and CHIP Programs
  • Tom Price: American Health Care Act CBO Score is Inaccurate
  • HHS Announces $157M for Accountable Health Communities Model
  • How Payers Could Compete in Midst of Health Insurance Mergers
  • Policy, Market Changes May Harm Employer-Sponsored Insurance
  • Payers, Providers Collaborate to Combat Opioid Abuse, Addiction
  • “This error rate equates to the program losing $46 billion annually due to provider misbilling. Unfortunately, the Medicare error rate continues to trend upward, having risen 1 significantly each of the past two years.”

    The analysis also offered nine other states that were found to have some of the highest levels of wasteful healthcare spending. The list includes Arkansas, Mississippi, North Dakota, Louisiana, Oklahoma, Colorado, Texas, New Mexico, and South Dakota.

    The Council for Medicare Integrity discovered that South Dakota – in 10th place – wasted less than half of the medical spending as the District of Columbia, which took first place. Vermont was the state with the smallest amount of wasteful healthcare spending per beneficiary with only $7.58 being billed inaccurately per consumer.

    North Dakota and South Dakota rank at the top as well when it comes to wasteful healthcare spending while at the same time having some of the smallest numbers of Medicare beneficiaries throughout the nation.

    “Medicare loses more money to waste than any other government program – $46 billion in FY2014 alone – and the billing error rate continues to be on the rise. This incredible loss of taxpayer dollars is one of the top reasons Medicare Trustees now say the program will be bankrupt within the next 15 years. Medicare auditing is more necessary than ever to ensure the program will be in place when we need it in the future. It’s time to stand up and ensure your Member of Congress supports the RAC program’s work to prevent the waste of your taxpayer dollars,” Kristin Walter, spokesperson for the Council for Medicare Integrity, said in a public statement.

    The analysis from the Council for Medicare Integrity also detailed rates of returned underpayments and the states with the smallest amount of wasteful healthcare spending within the Medicare fee-for-service program.

    The states with the least Medicare wasteful spending include New Hampshire, Wisconsin, Maine, Minnesota, Idaho, Massachusetts, Maryland, Oregon, and Rhode Island. Those with the least underpayments in the Medicare fee-for-service program include Maryland, Delaware, New York, Connecticut, Iowa, Montana, Pennsylvania, New Jersey, Wyoming, and Nebraska.

    The reason this analysis is so important is due to the breakdown of one potentially vital program within the federal government. The Recovery Audit Contractor program, which used to overlook and review Medicare billing as well as recover funds that were incorrectly paid out through CMS, has been scaled back since the beginning of 2014 due to pushbacks from hospitals.

    As such, it is important for the federal government to keep an eye on the states that have high levels of wasteful healthcare spending and reign in any problems before they escalate. The Council for Medicare Integrity analysis report will be a key step forward in addressing these concerns.

    “Each state must do their part to curb Medicare misbilling,” Walter continued. “If all entities involved made eradicating waste a priority, we would not have to worry about losing Medicare altogether in 2030.”


    Sign up for our free newsletter:

    Our privacy policy

    no, thanks

    Continue to site...