Part B Insider (Multispecialty) Coding Alert

Published on Tue Jan 23, 2018 PDF

Tip: Stay on top of your recertifications, guidance suggests.

This year's CERT supplemental data includes a handy breakdown of what it defines as "insufficient data," which accounted for approximately 64 percent of the improper payment rate and $23.2 billion improperly paid out to Medicare providers and suppliers.

"In order to provide a more thorough understanding of insufficient documentation errors, CMS examined the root causes of these errors and developed a universal error for the insufficient documentation error," explains the agency in the CERT report. "The root cause of the insufficient documentation error must meet the universal error definition to be included in that classification."

There are five "universal error" categories. According to the CERT data, 29.9 percent of the claims examined had more than one universal error. Here is this year's list with the definition and the percentages for 2017:

CMS 2017 Breakdown of Insufficient Documentation by Universal Error Category

*Data found in explanation of "universal errors" and Figure 6 of CERT report. 

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