decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 1 (January)
Coding errors on the decline
Subscribe or sign in to view the full article.
Article Overview
This article summarizes CMS Comprehensive Error Rate Testing (CERT) findings showing changes in physician practice coding accuracy, documentation-related errors, and improper payments over time. It is relevant to coders, compliance staff, and physician practices that track Medicare audit trends and error patterns across evaluation and management services and other claim categories.
Why This Topic Matters
Understanding CERT results helps coding and compliance teams monitor where claim errors are occurring and how audit findings are trending. The article provides context for Medicare payment integrity monitoring and highlights broad areas where practices may need closer review.
Article Sections
-
CMS CERT error rate results
Summarizes the latest CERT program findings, including the overall claim error rate and comparisons with prior reporting periods. It also notes how the reported rate relates to CMS benchmarks and program targets.
-
Common sources of improper payments
Reviews the broad categories most often associated with improper payments and describes the overall trend in those error types. The discussion stays focused on claim-level findings rather than detailed coding guidance.
-
Evaluation and management services with high error rates
Highlights the claim types and office-based and consultation services that appeared most frequently in error. The section places these services in the context of recurring audit findings and level-based coding variability.
-
Medically unnecessary services and payment trends
Covers the report’s findings for certain diagnostic groupings and the associated improper payment totals. It also summarizes broader Medicare payment trends and the relationship between overpayments and underpayments over time.
-
Analysis referenced in the article
Mentions an external analysis cited by the article and its interpretation of the CERT report’s payment figures. The section provides context for how the report data were discussed in the source material.
What You Will Learn
- How CMS CERT reports are used to track coding and documentation error trends
- Which general service categories were most often associated with claim errors
- How improper payments are discussed in relation to overall Medicare payment trends
- What broad findings were highlighted for evaluation and management services
- How the article frames the CERT data in the context of compliance and audit monitoring
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physician practice managers
- Revenue cycle professionals
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com