CERT: Is Your MAC Likely to Come Looking for Money You Still Owe?

Why This Topic Matters

CERT findings can signal where Medicare claims are most vulnerable to review, repayment, or denial. Practices can use this kind of information to focus internal compliance efforts on documentation quality, coding accuracy, and high-risk service categories.

Article Sections

1. CERT results and overall payment findings

   Summarizes the latest CERT review results and the overall direction of improper payment findings across Medicare fee-for-service claims. The section places the report in context for providers and MAC-related repayment activity.

2. Documentation and coding findings by claim type

   Describes the major categories of errors identified in the review and compares error patterns across Part A, Part B, and DME claims. It also notes the general kinds of documentation and coding problems observed.

3. Avoid These E/M Errors

   Focuses on evaluation and management claims and the broad factors associated with improper E/M payments. The section also touches on split/shared service review and the types of E/M services with the highest error rates.

4. California, New York Top Error List

   Reviews the state-level error ranking reported in the article and identifies the geographic areas with the highest percentages of errors. It frames the regional comparison as part of the CERT findings.