https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/index.html?redirect=/CERT

Read CERT 101 for an introduction to the CERT program. Select CERT Reports from the left menu tray on the CERT site. Choose the 2014 Medicare Fee-for-Service 2014 Improper Payments Report and review table 4. Your denials/error management team has reported that your overall 2014 Medicare claim error rates are as follows:

Error Category

Rate

No Documentation

.09%

Insufficient Documentation

9.3%

Medical Necessity

4.3%

Incorrect Coding

1.2%

Other

.20%

Overall Denial rate

15.09%

a. How does your hospital's error rate compare to the national rate?

b. What, if any, are your problematic areas?

c. What programs, if they are in place in your facility, would best help you to address the problematic areas?

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