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Home Health & Hospice Week

Industry Note:

Appeals Results Bring Down CERT Error Rates, OIG Says In New Report

Published on Thu Mar 22, 2012

The Medicare program's payment error rate may not be quite as bad as it first appears. In 2009, CMS estimated under the Com-prehensive Error Rate Testing program that Medi-care's payment error rate was 7.8 percent. In 2010, the figure was 10.5 percent. But if you take appeal results into account, those figures would have been 7.2 and 9.9 percent, respectively, the HHS Office of Inspector General notes in a new report. About 5.5 percent of the CERT claim payment denials for FY 2009 and 7.6 percent for FY 2010 were overturned during one of the first three levels of the appeals process, the OIG notes in a report summary. The OIG recommends including the appeals results in the error rate, and CMS agrees, according to the report at http://oig.hhs.gov/oas/reports/region1/11100504.pdf.
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