General Surgery Coding Alert - 2021 Issue 1
Improper Payment Rate: ‘Corrective Actions’ Decrease Overall Rates
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Article Overview
This article explains CMS’s FY 2020 Medicare improper payment findings and the broader factors behind the reported changes. It is relevant to coders, compliance staff, auditors, and healthcare organizations that follow Medicare fee-for-service payment integrity trends, documentation issues, and program integrity reviews. The discussion covers the CERT program, major error categories, and the types of corrective actions CMS says influenced the reported rates.
Why This Topic Matters
Understanding the Medicare improper payment report helps organizations monitor documentation and compliance risk areas that can affect claims payment integrity. The article also highlights CMS review activities and program changes that matter to providers working in high-risk service lines.
Article Sections
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Context and reporting background
Introduces the CMS improper payment reporting update and the role of the CERT program. Also notes the effect of COVID-19 on data collection and reporting methods.
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Here’s a Breakdown of the Numbers
Summarizes the overall estimated improper payment rate and compares it with the prior year. Also highlights broad changes across major Medicare service categories.
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Report Outlines Biggest Areas of Concern
Reviews the principal categories contributing to the Medicare fee-for-service improper payment estimate. Focuses on documentation, medical necessity, compliance, coding, and other reported error groupings.
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See How ‘Corrective Actions’ Impacted the Estimated Rates
Describes the program integrity and review activities CMS credits with helping reduce the estimated rates. Includes the types of provider and supplier reviews discussed in the report.
What You Will Learn
- How CMS reported FY 2020 Medicare improper payment estimates
- Which broad error categories contributed most to the reported rate
- What kinds of corrective actions CMS associated with the rate decline
- Which Medicare service areas were highlighted in the report
- How program integrity review efforts are discussed in the context of payment accuracy
Who Should Read This
- Medical coders
- Compliance officers
- Healthcare auditors
- Revenue cycle professionals
- Provider billing staff
- Healthcare administrators
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