decisionhealth Newsletters, Coder Pink Sheets - 2024 Issue 2 (February)
Compliance: CERT Alert – Part B error rate rises, telephone E/M services debut
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Article Overview
This compliance-focused article reviews recent Medicare CERT findings and highlights changes in improper payment patterns affecting Part B claims. It is aimed at coding, billing, and compliance professionals who monitor documentation risk, especially for evaluation and management services and telephone-based encounters. The article also points readers to supporting CMS documentation guidance and report data sources.
Why This Topic Matters
Understanding CERT error trends helps practices identify areas where claims are more likely to be denied or flagged for insufficient documentation. The article is especially relevant for teams responsible for documentation compliance, audit readiness, and reducing risk in evaluation and management reporting.
What You Will Learn
- How recent Medicare CERT results compare across reporting periods
- Which general claim categories are associated with improper Part B payments
- Why telephone-based evaluation and management services are receiving audit attention
- What documentation issues commonly contribute to insufficient documentation findings
- How CMS documentation guidance relates to medical record completeness
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle professionals
- Physician practices
- Auditors
Codes Discussed
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