Outpatient Facility Coding Alert - 2013 Issue 10
News You Can Use: CERT Results Show E/M Errors Top the Problem List
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Article Overview
This news article reviews CMS Comprehensive Error Rate Testing (CERT) findings for Medicare Fee-for-Service claims and explains where improper payments were concentrated. It is aimed at coders, compliance staff, billing personnel, and practices that want to understand error patterns affecting E/M claims, documentation, and split/shared services. The article also places the results in broader context by comparing Part B, Part A, DME, and geographic error rates, and by pointing readers to the CMS report for the full dataset.
Why This Topic Matters
CERT findings help practices understand the types of claim issues that most often trigger denials, overpayment recovery, or audit attention. The article is relevant for organizations monitoring documentation quality, coding accuracy, and Medicare payment integrity risk.
Article Sections
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CERT results and improper payment overview
Introduces the CMS CERT findings and summarizes the overall Medicare Fee-for-Service improper payment picture. It places the report in context across major claim categories and payment errors.
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Documentation and incorrect coding findings
Reviews the report’s broad categories of claim error, including documentation-related issues and coding accuracy. It compares error patterns across Medicare claim types at a high level.
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Avoid These E/M Errors
Focuses on the article’s discussion of evaluation and management claim issues identified in the CERT report. It highlights the article’s emphasis on common problem areas within E/M review.
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Split/shared services
Summarizes the article’s discussion of split/shared E/M claim review and documentation concerns. It addresses the broader compliance context for these services.
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California, New York Top Error List
Presents the report’s geographic comparison of error rates by state. It identifies the article’s summary of where the highest percentages of errors were found.
What You Will Learn
- How CMS CERT results describe Medicare Fee-for-Service improper payment trends
- What broad categories of claim errors were emphasized in the report
- Which types of E/M services were highlighted as higher-risk areas
- How split/shared services were discussed in the context of CERT findings
- Which states appeared at the top of the article’s error-rate discussion
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle teams
- Physician practices
- Healthcare auditors
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