tci Medicare Compliance & Reimbursement - 2008 Issue 37
CERT: Medicare Focusing On Payment Errors
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Article Overview
This article covers CMS’s latest Comprehensive Error Rate Testing (CERT) report and its discussion of improper payment rates in Medicare fee-for-service, Medicare Advantage, Medicaid, and SCHIP. It explains why the report matters to providers and payers by highlighting the role of documentation, medical necessity, and coding accuracy in payment integrity reviews, along with related oversight and review activity involving Medicare payment errors.
Why This Topic Matters
It helps coding, billing, compliance, and reimbursement professionals understand how CMS is reporting payment accuracy trends and why documentation and coding quality remain central to payment integrity oversight.
What You Will Learn
- How CMS measures and reports Medicare payment error rates
- Which public insurance programs were included in the error-rate review
- Why documentation, medical necessity, and coding accuracy are central themes in payment integrity
- How oversight and follow-up reviews relate to reported payment error findings
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Revenue cycle teams
- Healthcare administrators
- Payer policy analysts
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