In Audit
Jun 1st, 2018
If you just got one in the mail, don’t panic. Here’s why you probably received it, and how you should respond to it. The Comprehensive Error Rate Testing (CERT) program, which calculates the Medicare fee-for-service (FFS) program improper payment rate based on stratified random samples of Medicare FFS claims, continuously finds the same five leading causes ...
In Audit
Mar 4th, 2018
The Centers for Medicare & Medicaid Services (CMS) calculates the Medicare Fee-for-Service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Every year, CERT evaluates a statistically valid stratified random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules. A dispute may be filed ...
In Audit
Jan 26th, 2018
The Centers for Medicare & Medicaid Services (CMS) measures the fee-for-service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. According to a 2017 CERT report, CMS had a 90.5 percent proper payment rate and a 9.5 percent improper payment rate for all claims submitted July 1, 2015, to June 30, 2016. ...
In Coding
Nov 14th, 2016
As with most things, when documenting in the medical record, it’s best to “get it right” the first time. And because human memory isn’t as reliable as we’d like to believe, it’s also best to document the patient encounter as it is rendered, or as shortly thereafter as possible. When amendments, corrections, or delayed entries ...
Knowing the various entities reviewing your medical records for accuracy is half the battle. Any entity that is expected to pay your claims has the right to review the documentation that (hopefully) supports the services being billed. To prepare for the inevitable, you are wise to familiarize yourself with which entities may be interested in ...