Understand CERT Findings and What Your Organization Should Be Monitoring

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.

• 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

• 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

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.

• Physicians

• Medical Practice Administrators/Managers

• Medical Coding and Billing Organizations

• Compliance Officers

• CEO

• CFO

• Medical Billing Companies

• Medical Chart Auditing professionals

Pam Joslin, MM, CMC, CMIS, CMOM, CMCO, CEMA, CMCA-E/M has more than 20 years of medical practice management, billing and coding, reimbursement, auditing and compliance experience.

She is an engaging presenter via webinar, classroom and conference on various topics that may impact the revenue cycle of every practice and maintaining compliance.

She has managed in medical practices ranging from single to multi-specialty groups, including ASC. She is an advocate of process improvement and maximizing and empowering employees to bring about the "best practice” results for your organization.

She received her Masters in Management from University of Phoenix. Pam maintains memberships in professional organizations to support her continuing cycle of learning in the ever-changing healthcare industry.  Pam is the owner and operator of her consulting business, Innovative Healthcare Consulting.