Since 1996, Centers for Medicare and Medicaid (CMS) has implemented several initiatives to prevent improper payments. CMS’ goal is to reduce payment errors by identifying and addressing billing errors concerning coverage and coding. The Comprehensive Error Rate Testing (CERT) program is one of the program created by CMS to assist in eliminating improper payments for Medicare Fee for Services (FFS).
The Medicare Fee For Service (FFS) improper payment rate for 2017 was estimated at is 9.51% representing 36.2 billion dollars in improper payments, compared to the FY 2016 improper payment rate of 11.00 percent or $41.08 billion. Healthcare organization must be aware of the categories of improper payments audited by CMS and CERT so you can be proactive in resolving before they are sent to the carrier.
This webinar will introduce you to the CERT process, post-payment denial and the categories of improper payment that your organization should be monitoring. The expert speaker Pamela Joslin, MM, CMC, CMIS, CMOM, CMCO, CEMA, CMCA-E/M will also provide you the tools and techniques to use statistical sampling that mirrors what CERT measure – so you will be able to audit yourself. Participants will also know how to review your claims to ensure they comply with Medicare coverage, coding and billing rules. If a CERT reviewer determines that a Medicare Administrative Contractor’s payment decision was incorrect, the claim may be subject to payment adjustments, post-payment denials, or other actions.
Get empowered with new knowledge on the CERT process to make the organization more proactive in identifying the improper payment categories to maintain compliance. Develop process to identify your provider individual improper payment rates categorized by type, specialty and geographical location. This webinar will provide you great opportunity to see how your practice measures up to these national stats.
- To understand CERT process and what categories of improper payment categories your organization should be monitoring.
- To identify a process to select your provider’s statistical sampling of that mirrors what CERT measures so you can audit yourself before they do.
- To know how Comprehensive Error Rate Testing (CERT) contractors audit Medicare Part B by auditing you.
- To review your claims to see if they comply with Medicare coverage, coding, and billing rules, and if not, understand that errors may be assigned to the claims.
- To connect the role of your local Medicare Administrative Contractors (MAC)s and their responsibility for adjudicating claims based on Comprehensive Error Rate Testing (CERT) reviews.
- to get empowered with new knowledge on the CERT process and how your organization can be proactive in identifying your improper payment categories to maintain compliance.
- To develop process to identify your provider individual improper payment rates categorized by type, specialty and geographical location.
- To be more confident in responding to medical records requests by CERT within the required timeframes.
Areas Covered in the Session:
- Introduction to CERT Process
- Review improper payment categories
- How to respond to CERT medical record requests
- Recognize the CERT timelines for documentation submission
- Learn about local opportunities for training offered by CERT
- Take a look at specialties with high error rates for improper payments
- Track improper payment rates by your geographical location
- Opportunity to create or fine-tune your auditing/monitoring process
- Medical Practice Administrators/Managers
- Medical Coding and Billing Organizations
- Compliance Officers
- Medical Billing Companies
- Medical Chart Auditing professionals
About the Presenter:
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 the owner and operator of her consulting business, Innovative Healthcare Consulting. 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.
You will receive an email with login information and handouts (presentation slides) that you can print and share to all participants at your location.
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Headset: Any decent headset and microphone which can be used to talk and hear clearly
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