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 ...
Dec 1st, 2012
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 ...
Nov 1st, 2012
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 ...
Apr 1st, 2007
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-...