decisionhealth Newsletters, Part B News - 2007 Issue 12 (December)
Error rates continue decline, CERT report shows
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Article Overview
This article reviews CMS’s Comprehensive Error Rate Testing (CERT) report and its annual findings on Medicare claim accuracy. It covers overall error-rate trends, the main categories of claim problems identified by CMS, and the concentration of errors among common office visit and consultation E/M services. The piece is relevant to coding, compliance, and reimbursement audiences monitoring claim quality and improper-payment trends.
Why This Topic Matters
The article highlights CMS-reported shifts in error rates and improper payments, showing where claim-review and documentation issues remain concentrated. It is useful for organizations tracking Medicare compliance trends and understanding which broad service categories appear most often in erroneous claims.
What You Will Learn
- How CMS’s CERT program reports claim error-rate trends over time
- What broad types of claim errors CMS says are most common
- Which general E/M service categories appear most often among claims billed in error
- How improper payment totals compare with overall Medicare payment growth
- How CMS frames ongoing discussion of E/M coding variability
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Revenue cycle staff
- Physicians and practice managers
- Healthcare consultants
Codes Discussed
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