Medicare Compliance & Reimbursement

You'll draw CMS's attention if you fail to respond to Comprehensive Error Rate Testing (CERT) medical review requests. CMS staff will be making calls to providers that haven't responded to CERT requests for medical review, MACs Cahaba GBA, Noridian, Highmark, and Palmetto GBA say on their Web sites. "Although you may have already received letters and telephone calls from the CERT contractor, these additional efforts by CMS to obtain adequate documentation may change your claim's status from 'improper payment' to 'proper payment,'" they say. "This will allow us to calculate a more accurate Medicare FFS error rate, while also reducing the amount of improper payments." You might keep an eye on New York, which has developed a reputation for having one of the tougher Medicaid compliance enforcement efforts. The New York Association of Homes & Services for the Aging members are seeing "very aggressive tactics by Medicaid auditors," says Dan [...]