tci Part B Insider - 2016 Issue 34

Medicare Errors: E/M Factors Largely in Part B's 2015 Fee-For-Service Error Rate

Though CERT data helped decrease errors, improper payments are still in the billions. With five distinct components in place garnered from extensive Comprehensive Error Rate Testing (CERT) data, CMS saw a decreased fee-for-service improper error rate from 12.5 percent to 12.1 percent from 2014 to 2015. The adjusted rate did make a difference of about $1.4 billion, but the total outlay of improper Medicare payments still reached around $43.3 billion, a hefty sum by any standard. Background.To create the CERT report, CMS reviewed 49,603 claims, including Part A—with and without the Acute...

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