Error Rates and Provider Benefits
Error Rate Reports:
Providers may view the Error Rate Reports made available to the public on the CMS CERT web page. The November 2004 reports are now available on the web site. Each report shows the error rate data in chart form as well as a narrative of the CMS corrective action plans and goals.
The Three Error Rates that are measured with each report period twice a year are defined as:
- The FFS Paid Claims Error Rate measures the percentage of dollars CIGNA Government Services erroneously allowed.
- The Claims Processing Error Rate * measures if whether CIGNA made appropriate payment decisions.
- The Provider Compliance Error Rate * measures how well the providers prepared claims for submission as well as the timely submission of records.
Provider Benefits:
The purpose in determining the cause of errors is to enable the resolution of issues related to incorrect billing, processing and submission of claims and records. With improved processes, everyone will benefit, including the providers, the beneficiaries and the Medicare Trust Fund. It is CIGNA’s responsibility to protect the Medicare Trust Fund for the future needs of the beneficiary and provider communities. To facilitate this endeavor, it is important to ensure correct payment for services. This includes underpayment as well as overpayment for services.
Determining the cause for errors will enable CIGNA to address each specific area with relevant provider education and new review processes. The provider benefits will include:
- More accurate reimbursements
- More timely reimbursements
- Overall improved billing processes
- Fewer denials for incorrect or insufficient documentation
