Part B Insider - 2021 Issue 3
Check the Coding Errors That CMS Evaluated
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Article Overview
This article summarizes the major types of improper Medicare payment findings discussed in CMS’s 2020 CERT report. It is intended for coding and billing professionals who want a high-level view of common compliance problem areas, including documentation gaps, medical necessity issues, incorrect coding, and missing records. The article also highlights why these categories matter for audit readiness and claim review.
Why This Topic Matters
The article helps readers understand where Medicare payment errors most often occur so they can better assess documentation and claim accuracy risk. It is relevant for compliance, auditing, coding, and billing teams reviewing CERT-related error trends.
What You Will Learn
- The main categories CMS used to group improper Medicare payments in the CERT report
- How documentation-related findings are commonly framed in audit review
- How coding and reporting errors are discussed at a high level
- Why record support and claim substantiation are important in payer review
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Audit and reimbursement teams
- Physician practice managers
Codes Discussed
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