How CERT Data Is Used to Target Providers

Monitor Mondays

Auditors use the Comprehensive Error Rate Testing (CERT) study from the Centers for Medicare & Medicaid Services (CMS) as a way to target individual providers for potential recoupment. For example, if you get paid millions of dollars for some procedure codes or DRGs that have high error rates, it increases the likelihood that those specific codes and/or DRGs will be audited. Why? Because, statistically speaking, whatever the error rate reported by CERT is can help estimate the potential improper payments made to a given provider and/or organization.
During the next live edition of the venerable Monitor Monday broadcast, senor healthcare analyst Frank Cohen will return to continue his series on CERT.
Broadcast segments will include these instantly recognizable features:
•Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.
•The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.
•Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.
•Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.
•Lead Story: Senior healthcare analyst Frank Cohen will continue with his reporting on the CMS program CERT.

Chapters

1. How CERT Data Is Used to Target Providers (00:00:00)

2. Ronald Hirsch, MD (00:01:08)

3. Knicole Emanuel, Esq (00:05:37)

4. RACmontior Commercial (00:10:22)

5. David Glaser, Esq (00:11:40)

6. Matthew Albright (00:16:45)

7. RACmontior Commercial (00:21:15)

8. Frank Cohen (00:22:03)

9. Q&A With David Glaser (00:26:43)

10. Closing (00:30:03)