tci Part B Insider - 2021 Issue Q1

Compliance: CERT Shows Part B Error Rate Spiked in FY 2020

Tip: Ensure documentation proves medical necessity. Even though the overall Medicare fee-for-service (FFS) improper payment rate dropped for fiscal year (FY) 2020, Part B’s rate increased by almost 3 percent. Read on for the details. Context: On Dec. 21, 2020, the Centers for Medicare & Medicaid Services (CMS) released the 2020 Medicare FFS Supplemental Improper Payment Data as part of its Comprehensive Error Rate Testing (CERT) program. The CERT data showed Medicare Part B’s portion of the improper payment rate at 32.8 percent of the overall amount — a significant increase from the 2019 rate of...

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