decisionhealth Newsletters, Part B News - 2012 Issue 9 (September)
Benchmark of the Week: Services with highest improper payment rates, 2011
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Article Overview
This article summarizes CMS 2011 Comprehensive Error Rate Testing (CERT) findings on Medicare services with the highest improper payment rates and their share of overall fee-for-service payment error. It is intended for billing, coding, and compliance audiences who want a high-level view of where Medicare claim errors were most concentrated and why those areas drew attention. The discussion covers broad categories of improper payments, documentation-related issues, and service areas that contributed significantly to the overall error picture.
Why This Topic Matters
Understanding where Medicare improper payments are concentrated helps coding and compliance teams focus review efforts on high-risk service categories and documentation practices. The article also highlights how utilization patterns can make even moderate error rates material to overall payment integrity.
What You Will Learn
- How CMS CERT data is used to benchmark Medicare improper payment trends
- Which broad service categories contributed most to overall payment error
- Why documentation and coding issues matter in high-volume Medicare services
- How service-level error patterns can inform compliance and audit focus
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Revenue cycle professionals
- Healthcare administrators
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