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2020 Report on Improper Medicare Payments

2020 Report on Improper Medicare Payments December 28, 2020
The 2020 Comprehensive Error Rate Testing (CERT) report was published last week.  The report details information regarding fee-for-service (FFS) payment errors made under both Part A and Part B.  The findings reflect payment errors of $25.7 billion for fiscal year 2020.  The volume and types of errors noted suggest providers continue to struggle with appropriate documentation and accurate coding to support coverage and reimbursement in the outpatient and inpatient setting. 
 
The top 5 CPT errors were related to:
Chronic care management Drug testing
Chiropractic manipulative treatment (CMT)
Annual wellness visits 
Therapeutic exercise/physical therapy

The top 5 DRG errors were related to:
Chest pain
Percutaneous intracardiac procedures
Hip and knee joint replacements
Cardiac defibrillator implants
Endovascular cardiac valve replacements Cervical spinal fusions

We have summarized the key errors from the report.
We recommend reviewing the complete report in detail.  If you routinely provide and bill for the types of services identified within the CERT report, we recommend you incorporate them into your compliance and auditing and monitoring program work plan. 

The complete CERT report is here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports
 
HBE’s team of coding and compliance experts is available to assist you with identifying the risks unique to your organization as well as providing assistance with conducting documentation, coding, medical necessity and coverage audits.  We also offer customized education and training for your physicians, coders and executive leadership.

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel.

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