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Medicare Compliance & Reimbursement

INDUSTRY NOTES:

OIG Finds CMS's CERT Results Inaccurate

Published on Tue Sep 22, 2009

Plus: Keep medication units in check with MAC-approved drug calculator tool. Each year, CMS releases its Comprehensive Error Rate Testing (CERT) results, outlining areas where Medicare may have made improper payments. But now it appears that the CERT results themselves may be riddled with errors. The OIG conducted a review of the 2008 CERT results and found that the actual error rate was more than double what CMS's CERT contractor actually found. In some cases, the difference in error rates was due to "professional judgement" regarding how the auditor interpreted the medical documentation, but in other instances, CMS's original CERT contractor agreed that it had missed certain errors in medical documentation. To read the complete OIG report, visit www.oig.hhs.gov/oas/reports/region1/10900511.pdf. • When Part B MACs publish the top errors that they see in claims submitted by physicians, incorrectlybilled drugs are always near the top of the list. If you're one [...]
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