Outpatient Facility Coding Alert - 2015 Issue 1
Medicare Errors: Let CERT Findings Focus E/M Claims
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Article Overview
This article summarizes Medicare CERT and related CMS improper payment findings and explains how they relate to evaluation and management claim compliance. It is aimed at physicians, coders, billing staff, and compliance teams that want to understand the main categories of claim error, documentation gaps, and audit-related risks discussed in CMS reporting and provider guidance. The article focuses on broad error patterns, E/M claim review, split/shared service concerns, and practical preparation for responding to medical record audits.
Why This Topic Matters
CERT findings can signal where Medicare claims are most vulnerable to denial, refund requests, or additional scrutiny. Understanding the article helps providers and billing teams focus compliance efforts on documentation quality, correct E/M reporting, and audit readiness.
Article Sections
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Get Familiar With CERT Report
Introduces the CMS CERT report and summarizes the broad categories of claim errors identified in Medicare fee-for-service review. It also discusses how the findings are used to frame compliance and documentation concerns.
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Recognize E/M Errors
Focuses on evaluation and management claims as a major area of improper payment risk and discusses the types of documentation and coding issues associated with those claims. The section also touches on split/shared service review and audit preparation.
What You Will Learn
- How CMS CERT findings are used to identify common Medicare claim error patterns
- Why evaluation and management claims receive particular compliance attention
- What general documentation and coding issues are associated with improper payment findings
- How split/shared service claims fit into the broader audit risk discussion
- What to consider when organizing records for a Medicare audit response
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
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