CERT audit for contractors could cost your clinic
Briefings on Outpatient Rehab: Reimbursement and Regulations, April 1, 2009
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With so much attention on the recovery audit contractors (RAC) and other new audits that could cause rehab providers to lose money, therapy managers sometimes overlook older programs that could have similar effects.
It’s more likely that a program could be overlooked when the goal of the program isn’t to review providers, but contractors. However, when CMS established the Medicare Comprehensive Error Rate Testing (CERT) program in 2003, the program had unintended consequences for providers, says Nancy J. Beckley, MS, MBA, CHC, president of Bloomingdale Consulting Group in Brandon, FL.
Established to monitor and report the accuracy of Medicare payments, the CERT program audits Medicare contractors to ensure that they are reviewing and paying claims correctly. But when an error is found, the contractors can return to the provider and request repayment of the reimbursement, says Beckley. “In trying to assess the payment error rate of contractors, the auditors have to look at claims,” she says. “So inadvertently, rehab claims end up getting checked and errors are found."
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