How CERTain Are We About the CERT Results?
By Frank Cohen, Director of Analytics and Business Intelligence
As originally published by Racmonitor.com
I recently was reading through the Nov. 15 Centers for Medicare & Medicaid Services (CMS) blog post written by Shantanu Agrawal, M.D., Deputy Administrator and Director for Center for Program Integrity, and Jennifer Main, Director and Chief Financial Officer for Office of Financial Management.
The post was titled “CMS corrective actions cut improper payment rate for inpatient hospital claims by a massive 58.3 percent over the past couple of years.” It was a good read, but it highlighted continued problems that I have with CMS regarding transparency and accuracy.
For the uninitiated, CERT stands for Comprehensive Error Rate Testing, and it is a program that was started by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) in 1996 to study the rate at which improper payments were being made to healthcare providers.