tci Medicare Compliance & Reimbursement - 2020 Issue Q1
Coding Errors: Documentation Struggles Top CERT Report
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Article Overview
This article reviews CMS’s 2019 CERT improper payment findings for Medicare Fee-for-Service and explains why documentation problems remain a major compliance issue. It discusses broad program trends across Medicare parts and service categories, the role of corrective actions and education initiatives, and how providers can use CERT information to assess documentation, auditing, and internal compliance practices. It is relevant for coders, billers, auditors, compliance staff, and practices that submit Medicare claims.
Why This Topic Matters
The article helps healthcare organizations understand where Medicare improper payments are concentrated and why record quality continues to drive audit risk. It is useful for identifying high-level compliance priorities without exposing premium coding guidance.
Article Sections
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CERT report overview and improper payment trends
Introduces CMS’s annual CERT data and summarizes the overall direction of Medicare improper payment rates. It also places the report in the context of broader claims oversight and payment integrity efforts.
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CMS targets three areas to reduce improper payments
Reviews the main service areas CMS highlights as contributing to reduced improper payments. It discusses broad program actions and initiatives tied to those reductions.
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Insufficient documentation remains primary issue
Describes the leading documentation-related problem areas identified in the report across Medicare claim types. It also notes the role of record accuracy in improper payment findings.
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How CERT data impacts your practice
Explains the general ways CMS uses CERT information for oversight, education, and program integrity. It also outlines why providers are encouraged to review their own compliance and documentation processes.
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California and Texas bump up the overall improper payment rate
Summarizes the geographic error-rate comparison included in the article. The section places state-level results within the broader Medicare improper payment discussion.
What You Will Learn
- How CMS uses CERT data to measure Medicare payment errors
- Which broad Medicare service areas are discussed in connection with improper payment reductions
- Why documentation quality remains a major focus in claims review
- How CERT findings support auditing, education, and compliance monitoring
- What the article says about state-level improper payment variation
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Clinical documentation staff
- Practice managers
- Auditors
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