INDUSTRY NOTES: OIG Finds CMS's CERT Results Inaccurate

Why This Topic Matters

The update highlights areas where claims, reporting, and compliance processes may be affected by payer reviews, contractor tools, enforcement activity, and CMS measurement changes. It helps readers monitor operational changes and risk areas across Medicare billing and quality reporting.

Article Sections

1. CERT review findings

   A review of CMS CERT results and related Medicare payment accuracy concerns. The section discusses audit findings and how the reported results compare with a separate review.

2. MAC drug lookup and calculator tool

   A Medicare contractor resource for drug unit calculation and claim support. The section explains the purpose of the tool and notes that it displays allowable unit information.

3. Stark law and Civil Monetary Penalties Law settlement

   An enforcement update involving a hospital director and alleged financial arrangement issues. The section also references related Medicare claims and compliance concerns.

4. Medicare Secondary Payer claim suspense

   A contractor notice about Medicare Secondary Payer claim processing delays. The section summarizes the reported systems issues and the expectation for claims to complete processing.

5. OASIS C outcome measures changes

   CMS guidance on reporting changes tied to the OASIS C data set. The section outlines the general categories of reports and the timing of future revisions.