tci Medicare Compliance & Reimbursement - 2021 Issue Q1
Compliance: CERT: Documentation Issues Plague Providers
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Article Overview
This article summarizes Medicare Fee-for-Service Comprehensive Error Rate Testing (CERT) results for fiscal year 2020 and explains why the findings matter for compliance, billing integrity, and documentation oversight. It covers the major categories contributing to improper payments, the relationship between CERT data and provider education, state-level variation in error patterns, and CMS updates related to the public health emergency and later audit activity. The piece is aimed at providers, coders, compliance staff, and revenue cycle teams who track Medicare audit risk and documentation quality.
Why This Topic Matters
CERT findings help organizations understand where Medicare claim errors are occurring and what issues are driving payment risk. This information is useful for improving documentation processes, monitoring compliance exposure, and prioritizing education around high-risk claim problems.
What You Will Learn
- How CMS uses CERT data to measure Medicare Fee-for-Service payment accuracy
- Which broad claim problem areas are highlighted in the FY 2020 CERT results
- How state-level improper payment patterns are presented in the report
- What CMS changes were made to CERT activities during and after the public health emergency
Who Should Read This
- Physicians
- Medical coders
- Compliance professionals
- Billing staff
- Revenue cycle teams
- Practice administrators
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