January 7, 2008
CERT Improper Fee-for-Service (FFS) Error Rates
November 2007 Improper Medicare Fee for Service Payment Report Results
The Centers for Medicare & Medicaid Services (CMS) has published the November 2007 Improper Medicare Fee-for-Service Payments Reports. These fi ndings are a result of the Comprehensive Error Rate Testing (CERT) Program and percentages are based on those CIGNA Government Services Medicare Part B claims and services randomly selected and used for sampling purposes.
CIGNA Government Services wishes to thank all Part B providers and their staffs who responded and sent copies of documentation in response to CERT records requests. We recognize it is an additional task to include with the ongoing medical and administrative demands of a practice. Your cooperation helped to decrease the paid claim error rate, and helped us to pay you correctly for services you rendered to Medicare beneficiaries.
The following CERT Error Rates were published in the November 2007 report:
- National Paid Claims Error Rate is 3.9% (this equates to $10.8B)
- North Carolina Paid Claims Error Rate is 4.5%
- Idaho Paid Claims Error Rate is 2.1%
- Tennessee Paid Claims Error Rate is 3.0%
Also published in the November 2007 report were the CMS goals for future CERT Error Rates:
- November 2008 Report – 3.8%
- November 2009 Report – 3.7%
Additional information and findings may be accessed through the CMS Web site at http://www.cms.hhs.gov/CERT/CR/list.asp.
Again, we would like to thank the entire provider community and staff members for past and future efforts directly contributing to the CERT error rate reductions. We do recognize and appreciate your labors. Congratulations!
