ED Coding & Reimbursement Alert - 2021 Issue 3
Compliance: CERT Shows Part B Error Rate Spiked in FY 2020
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Article Overview
This article summarizes CMS’s FY 2020 Comprehensive Error Rate Testing (CERT) findings for Medicare fee-for-service claims, with a focus on why Part B improper payments increased and what broad documentation problems were most associated with the errors. It also explains how CMS reported the data, how the findings compare with the prior fiscal year, and why the results matter to providers monitoring compliance and medical necessity documentation.
Why This Topic Matters
CERT results help providers and billing teams understand where Medicare claims errors are occurring and what documentation weaknesses are commonly associated with improper payments. The article is relevant to compliance, coding, and reimbursement staff who want to interpret CMS oversight trends and prepare for future review activity.
Article Sections
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Context and CERT data release
Introduces the CMS data release and places the FY 2020 findings in the broader Medicare fee-for-service compliance setting. It explains the reporting framework and the time period reflected in the analysis.
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Take a Look at the Overall Numbers
Summarizes the overall improper payment figures and compares them with the previous fiscal year. It also describes the general purpose of the CERT program and the role of education and corrective actions.
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Pocket These Part B Particulars
Focuses on Part B documentation-related error categories identified in the CERT results. It highlights the broad types of recordkeeping problems discussed in the article.
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See State with Highest Percentage of Improper Payments
Reviews state-level improper payment and error-rate rankings presented in the CERT data. It also notes the temporary program disruption and later resumption of review activity during the public health emergency.
What You Will Learn
- How CMS presented FY 2020 CERT results for Medicare fee-for-service
- What broad trends were reported for Part B improper payments
- Which general documentation problem categories were associated with Part B errors
- How state-level improper payment patterns were summarized in the report
- How the CERT program was affected by the public health emergency and later resumed
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle professionals
- Medicare provider organizations
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