BC Advantage - 2017 Issue 10

Avoid Denials and Mitigate Risk Under the CMS CERT Program

Insufficient documentation is by far the most common reason for denying a claim or improperly paying a claim. Improperly paid claims become problematic after identification by the Center for Medicare and Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT), a random sampling of claims evaluated for compliance with Medicare coverage, coding and billing rules.  After a claim has been identified by CERT, an initial request for records and documentation is sent to the submitting provider or supplier via a medical record documentation request.  Up to three subsequent requests for information are sent if no additional documentation...

To read the full article, sign in and subscribe to BC Advantage.

Access to this feature is available in the following products:
  • BC Advantage, 30+ CEUs & Webinars

free demo
request yours today
pricing
for any budget
sign IN
welcome back!