Does the CERT program also identify undercoding?

Does the CERT program also identify undercoding?

• A. No, it only focuses on overcoding
• B. No, it does not consider coding errors
• C. Yes
• D. Yes, but only in specific cases

Answer: (C)

The CERT (Comprehensive Error Rate Testing) program is designed to identify improper payments in Medicare claims, which includes both overcoding and undercoding. Under coding occurs when a healthcare provider uses a lower level of code than what is warranted for the services rendered, which can lead to substantial revenue loss for healthcare practices. The CERT program assesses the accuracy of coding practices across various claims and can flag instances where undercoding occurs. This thorough approach ensures that the program promotes integrity in billing practices, allowing for appropriate levels of reimbursement for healthcare services provided. Thus, the affirmation that the CERT program identifies undercoding aligns with its objective of maintaining correct billing practices.

The CERT (Comprehensive Error Rate Testing) program is designed to identify improper payments in Medicare claims, which includes both overcoding and undercoding. Under coding occurs when a healthcare provider uses a lower level of code than what is warranted for the services rendered, which can lead to substantial revenue loss for healthcare practices. The CERT program assesses the accuracy of coding practices across various claims and can flag instances where undercoding occurs. This thorough approach ensures that the program promotes integrity in billing practices, allowing for appropriate levels of reimbursement for healthcare services provided. Thus, the affirmation that the CERT program identifies undercoding aligns with its objective of maintaining correct billing practices.