Compliance: CERT: Documentation Issues Plague Providers

Why This Topic Matters

CERT data is a key source of Medicare compliance intelligence because it highlights where claim errors are occurring and where documentation or coding processes may need attention. Understanding these findings helps organizations focus education, audit readiness, and internal controls.

Article Sections

1. Context

   Introduces the CMS CERT program and explains the reporting context for the FY 2020 Medicare fee-for-service data. It also notes the relationship between the fiscal year and the sampling period used for the report.

2. Take a Look at the Overall Numbers

   Summarizes the overall Medicare fee-for-service improper payment results for FY 2020 and compares them with the prior year. It also explains the general purpose of the CERT program for claim review and education.

3. Review These Error Rate Particulars

   Describes the main categories contributing to improper payments in the FY 2020 results. The section focuses on broad error drivers such as documentation, medical necessity, and coding.

4. See State With Highest Percentage of Improper Payments

   Reviews state-level patterns in the CERT data and highlights variations in improper payment rates across jurisdictions. It also mentions how the report presents these comparisons.

5. Important

   Notes temporary CERT program changes during the COVID-19 public health emergency and the resumption of certain review activities. It also references reporting-year adjustments and provider contact timing.