Comprehensive Error Rate Testing (CERT) Background.pdf Download Comprehensive Error Rate Testing (CERT) Background.pdffor an introduction to the CERT program.

Read Comprehensive Error Rate Testing (CERT) Background.pdf Download Comprehensive Error Rate Testing (CERT) Background.pdffor an introduction to the CERT program.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/Background

Open the MedicareFeeforService2014ImproperPaymentsReport.pdf     LINK: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/Downloads/MedicareFeeforService2014ImproperPaymentsReport.pdf#:~:text=The%20estimated%202014%20Medicare%20FFS%20improper%20payment%20rate,Fiscal%20Year%20%28FY%29%202014%20HHS%20Agency%20Financial%20Report.  

and review table 4. Your denials/error management team has reported that your overall 2014 Medicare claim error rates are as follows:

A table that shows the overall 2014 Medicare claim error rates for a hospital Error Category Rate No

Documentation 09% Insufficient 9.3% Documentation Medical Necessity 4.3% Incorrect Coding 1.2% Other

20% Overall Denial rate 15.09%

How does your hospital’s error rate compare to the national rate?

What, if any, are your problematic areas?

What programs, initiatives, or teams typically utilized by hospitals would best help you to address the problematic areas?

What additional steps might the hospital take to address these issues?

Go to the National Correct Coding Initiative Edits Links to an external site.(CMS website).

https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare

Select PTP Coding Edits from the left menu tray.

Select the most current version of the Hospital PTP Edits and open the file containing Column 1 code 37213.

Review the PTP edit file and explain how you would address each of the issues.

Scenario: You are reviewing pre-billing claims and observe that the following claims are failing for mutually exclusive code edit.

exclusive code edit. A table that shows the mutually exclusive code edits for claims Code 1 Code 2 Claim 1

37217 93050 Claim 2 38794 69990 Claim 3 11306 12034 Claim 4 35518 35587 Your wrist Hen response

should consist of a minimi