Comprehensive Error Rate Testing (CERT) is a CMS program that helps reduce improper payments in Medicare Fee-for-Service by finding coverage and coding errors. This 60-minute CERT audit training explains how the process works and what your organization should monitor.
CMS has run initiatives against improper payments since 1996, and the FFS improper payment amount for 2017 was estimated at $36.2 billion. You'll review improper payment categories, how CERT contractors audit Medicare Part B, how to respond to medical record requests and documentation deadlines, and how reviewers decide a MAC's payment was wrong.
You'll also see specialties with high error rates, local CERT training and how to compare rates by location.
WHY SHOULD YOU ATTEND?
If you know what CERT measures, you can audit yourself first. This session shows how to pick a statistical sample of your providers that mirrors CERT and track individual improper payment rates by type, specialty and location, so you can compare your practice with national figures.
It suits physicians, practice administrators, coding and billing organizations, compliance officers, CEOs, CFOs and chart auditors.
AREA COVERED
- Introduction to the CERT process
- Improper payment categories
- How CERT contractors audit Medicare Part B
- Responding to CERT medical record requests
- CERT timelines for documentation submission
- How CERT reviewers determine a MAC payment decision was incorrect
- The role of local Medicare Administrative Contractors in adjudicating claims
- Local training opportunities offered by CERT
- Specialties with high improper payment error rates
- Tracking improper payment rates by geographic location
- Creating or fine-tuning your auditing and monitoring process
LEARNING OBJECTIVES
- Explain the CERT process and the improper payment categories to monitor
- Describe how CERT contractors audit Medicare Part B claims
- Respond confidently and on time to CERT record requests
- Explain how CERT reviewers judge a MAC payment decision incorrect and the MAC's role
- Compare your specialty geographically using the CERT annual report
- Build a self-audit sample that mirrors CERT measures
WHO WILL BENEFIT?
Physicians
Medical Practice Administrators/Managers
Medical Coding and Billing Organizations
Compliance Officers
CEO
CFO
Medical Billing Companies
Medical Chart Auditing professionals
If you know what CERT measures, you can audit yourself first. This session shows how to pick a statistical sample of your providers that mirrors CERT and track individual improper payment rates by type, specialty and location, so you can compare your practice with national figures.
It suits physicians, practice administrators, coding and billing organizations, compliance officers, CEOs, CFOs and chart auditors.
- Introduction to the CERT process
- Improper payment categories
- How CERT contractors audit Medicare Part B
- Responding to CERT medical record requests
- CERT timelines for documentation submission
- How CERT reviewers determine a MAC payment decision was incorrect
- The role of local Medicare Administrative Contractors in adjudicating claims
- Local training opportunities offered by CERT
- Specialties with high improper payment error rates
- Tracking improper payment rates by geographic location
- Creating or fine-tuning your auditing and monitoring process
- Explain the CERT process and the improper payment categories to monitor
- Describe how CERT contractors audit Medicare Part B claims
- Respond confidently and on time to CERT record requests
- Explain how CERT reviewers judge a MAC payment decision incorrect and the MAC's role
- Compare your specialty geographically using the CERT annual report
- Build a self-audit sample that mirrors CERT measures
Physicians
Medical Practice Administrators/Managers
Medical Coding and Billing Organizations
Compliance Officers
CEO
CFO
Medical Billing Companies
Medical Chart Auditing professionals