Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 12, 2009 PDF

Plus: OIG nabs California hospital director for alleged violations of the Stark and Civil Monetary Penalties laws.

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.