tci Medicare Compliance & Reimbursement - 2024 Issue Q1

Compliance: CMS Reports Slight Error Rate Decrease For 2023

Documentation and medical necessity challenges top list of CERT woes. The feds made some strides as the overall improper payment rate declined for Medicare Fee-for-Service (FFS) claims. But, the CERT news isn’t all great since Part B providers’ error rates went up — big time. Context: On Dec. 7, 2023, the Centers for Medicare & Medicaid Services (CMS) published its “2023 Medicare Fee-for-Service Supplemental Improper Payment Data” report as part of its Comprehensive Error Rate Testing (CERT) program. CMS uses CERT data to estimate the scope and scale of improper payments and measure the claims error rate...

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