decisionhealth Newsletters, Part B News - 2010 Issue 2 (February)
Fee-for-service error rate doubles to 7.8%, new report finds
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Article Overview
This article reviews CMS’s latest Comprehensive Error Rate Test (CERT) findings for Medicare fee-for-service claims, explaining why the reported error rate increased and what broad categories of claim problems were identified. It also highlights examples of local CERT reports from Medicare contractors and discusses the types of documentation, medical necessity, and coding issues that prompted audit findings. The piece is relevant to clinicians, billing staff, coders, compliance teams, and Medicare providers who track audit risk and contractor-specific error data.
Why This Topic Matters
CERT reports are a key source of Medicare audit and improper payment information. Understanding the kinds of issues identified in national and local reviews helps providers focus compliance and documentation efforts.
Article Sections
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CMS CERT findings and national fee-for-service error trends
Summarizes the national Medicare fee-for-service error-rate results and the broad factors associated with the increase. Discusses the role of the CERT review process and improper payment reporting.
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Local error rates
Introduces contractor-level CERT information and explains that local MAC and carrier reports may provide additional jurisdiction-specific data. Points readers to regional sources of error-rate information.
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Examples from TrailBlazer, Highmark, and WPS
Provides selected examples from Medicare contractor reports and specialty-specific reviews. Highlights the kinds of claim issues identified in different jurisdictions and service categories.
What You Will Learn
- How the CERT program is used to report Medicare fee-for-service improper payments
- What broad categories of claim problems were highlighted in the article
- Why local MAC and carrier CERT data can be useful
- How contractor-level reports may differ by jurisdiction and specialty
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Physician practices
- Medicare providers
- Audit and revenue integrity professionals
Codes Discussed
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