Compliance: CERT: Documentation Issues Plague Providers

Why This Topic Matters

CERT data helps providers and revenue cycle teams understand where Medicare claims are most vulnerable to denial or overpayment findings, especially when documentation and coding issues are driving the largest share of improper payments.

Article Sections

1. Context and CERT program background

   Introduces the Medicare Fee-for-Service CERT program and explains the reporting context for fiscal year 2020. Summarizes the general purpose of the program and how the reporting period relates to the fiscal year.

2. Take a Look at the Overall Numbers

   Presents the overall Medicare FFS improper payment figures for fiscal year 2020 and compares them with the prior year. Discusses the broad significance of the reported trend.

3. Review These Error Rate Particulars

   Describes the main categories contributing to improper payments in the CERT results. Focuses on documentation, medical necessity, and coding as broad problem areas.

4. See State With Highest Percentage of Improper Payments

   Summarizes the geographic comparison of improper payment rates across selected states and territories. Notes that smaller jurisdictions may show higher percentages in the CERT data.

5. CERT program changes during the COVID-19 public health emergency

   Explains how CERT activities were temporarily adjusted during the public health emergency and references reporting-year changes. Notes the resumption of provider contact and related audit activity.