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MACs Now Get Two CERT Disputes Per Month

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In Audit
Mar 4th, 2018
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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 ...
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Get Ready: The RACs are Coming!

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In Industry News
Dec 1st, 2012
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By Amy Lee Smith, MBA, CPC, CPC-H, CPMA, CIA, CRMA  Preparing for, and responding to, recovery audit contractor (RAC) reviews can be intimidating. You can lessen the pain, however, by understanding Medicare billing and coding rules and requirements, and being proactive in implementing controls to ensure compliance. RACs Review Across the Nation Section 302 of ...
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Compliance Is Not a 4-letter Word

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In Industry News
Nov 1st, 2012
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By David Lane, PhD, CHC, CPC, CAPPM “Compliance” often conjures up images of boring lectures, law enforcement, huge fines, scary “I’m from the government and I’m here to help” mentality, and worse. In reality, compliance is an integral part of the health field. And with health care reform and the Patient Protection and Affordable Care ...
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Coding Errors

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In Industry News
Apr 1st, 2007
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By Chris Fraizer, CPC, CPC-H, CPC-P Documentation no longer holds first place for claims rejection, according to the latest results of the Comprehensive Error Rate Testing (CERT) program of the Centers for Medicare and Medicaid Services (CMS). But the not so good news: Coding errors now hold that distinction (see accompanying table). “Coding errors are skyrocketing,” says Diana Lerro, BSN, RN, CPC-...
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