General Surgery Coding Alert - 2014 Issue 18
Medicare Errors: Will Your MAC Come Asking For Money Back?
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Article Overview
This article reviews CMS’s 2013 Comprehensive Error Rate Testing (CERT) results for Medicare fee-for-service claims and explains the broad categories of billing and documentation problems found across Part A, Part B, and durable medical equipment claims. It is relevant to coders, billing staff, compliance teams, and providers who want to understand the types of claim errors that contributed to improper payments and the overall Medicare audit environment.
Why This Topic Matters
The article helps readers understand why Medicare claims may be subject to repayment review and highlights the operational areas most associated with improper payments, especially for Part B and E/M services. It is useful for identifying compliance focus areas and understanding the kinds of issues CMS reports as driving claim errors.
What You Will Learn
- How CMS’s CERT program evaluates Medicare fee-for-service claim errors
- What broad categories of claim issues were most common in the 2013 report period
- Why documentation and coding accuracy are central to Medicare compliance reviews
- How evaluation and management claim review was discussed in the article
- Which geographic areas were highlighted in the report as having higher error rates
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physicians and group practices
- Revenue cycle teams
- Practice managers
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