DecisionHealth, DecisionHealth - 2006 Issue 6 (June)
Compliance improves, but some errors spike
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Article Overview
This article summarizes Medicare CERT findings on provider claim compliance during a recent sampling period and compares error trends across medical specialties. It is relevant to physicians, therapists, practice managers, and coding/compliance professionals who monitor claim preparation quality, documentation response issues, and the impact of CMS education or policy changes on billing performance. The discussion is broad and analytical rather than code-specific, focusing on reported specialty error rates and factors that may have contributed to improvement or spikes.
Why This Topic Matters
Understanding specialty-level compliance trends helps organizations track risk areas in claim submission and documentation processes. The article also shows how CMS policy changes and education efforts can affect billing performance over time.
What You Will Learn
- How CERT reporting is used to assess provider claim compliance
- Which specialties experienced notable changes in reported error rates
- How CMS education and policy changes may affect compliance trends
- Why documentation requests and non-responses can affect measured error rates
Who Should Read This
- Physicians
- Medical practice administrators
- Coding and billing professionals
- Compliance officers
- Therapists and therapy group practices
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