Optum360 coding books logo
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
February 14, 2018

Select States and Territories to Be First to Receive New Medicare Cards

The Centers for Medicare and Medicaid Services announced its mailing strategy over the course ... Learn More

New Payment Model Qualifies as APM

The Centers for Medicare and Medicaid Services (CMS) is rolling out a new payment model to begin ... Learn More

MAO Provider Directories Frustrate Would-Be Patients, CMS Finds

In a review completed in August 2017, the Centers for Medicare and Medicaid Services (CMS) dis... Learn More

View Article Archive

To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:

Medical Coding News Archives

New CERT Report Reveals E/M Errors Remain High

January 22, 2008:
The Centers for Medicare and Medicaid Services (CMS) has released the most recent results of the latest Comprehensive Error Rate Testing Program (CERT), and included in the report is a list of the most overutilized codes. Topping the list once again are evaluation and management services.

As you can see from the table below, five of the top six errors relate to evaluation and management services and the chief cause of the errors is incorrect coding.

Top Service Type Error Rates: Carriers and MACs
Service Type Billed to Carriers (BETOS codes)Paid Claims Error Rate95% Confidence IntervalType of Error
No Doc.Insuff. Doc.Med. Unnec. SvcsIncorrect CodingOther
Hospital visit—initial14.5%11.9%–17.0%5.4%15.3%0.0%75.3%4.0%
Office visits—new14.5%12.3%–16.6%0.0%2.3%0.2%96.9%0.5%
Nursing home visit12.5%10.6%–14.3%13.9%16.3%0.8%68.9%0.0%
Hospital visit—subsequent11.3%10.0%–12.7%9.5%33.0%0.1%53.6%3.7%

CMS uses the CERT results to implement changes that will lower the paid claims error rate. Some of these efforts, listed below, include using the First Look Analysis Tool for Hospital Outlier Monitoring (FATHOM) that generates state-specific hospital billing reports to help quality improvement organizations (QIOs) analyze administrative claims data and target interventions with hospitals.
  1. Continuing one-on-one educational contacts with providers with indicators of high levels of payment errors
  2. Developing projects with the QIOs addressing state-specific admissions necessity, coding, and billing concerns
  3. Distributing FATHOM-generated hospital-specific reports
  4. Developing and distributing QIO-specific payment error cause analyses
  5. Conducting national training on the use of FATHOM reports in compliance efforts
Your practice can use the CERT study to identify areas of potential risk and determine where additional education and training are needed.

Deborah C. Hall
Clinical/Technical Editor


Sign in to
Your Account
Forgot your username?
Forgot your password?
Don't have an account?
It's easy to create one.
Promo code

Have a promotional source code? Enter it here:

What is this?

Code This!

Test your coding knowledge!