Effective August 11, 2020, the Centers for Medicare & Medicaid Services resumed the Comprehensive Error Rate Testing program activities that were temporarily suspended in response to the public health emergency for the 2019-Novel Coronavirus (COVID-19) pandemic. CMS uses Comprehensive Error Rate Testing to verify Medicare Administrator Contractors are properly paying claims. CERT audits coding and billing to improve the quality and accuracy of Medicare claim submission and payment of those claims. CERT identified the top error-prone MS-DRGS for FY 2019.
Below are the top MS-DRGS identified as having coding errors as either their Primary or Secondary error type:
- 871, 872 Sepsis without mechanical vent greater than 96 hours
- 291, 292, 293 Heart failure and shock
- 308, 309, 310 Cardiac arrhythmia and conduction disorders
- 515, 516, 517 Other musculoskeletal system/connective tissue disorders
- 689, 690 Kidney and Urinary tract infection
- 981, 982, 983 Extensive OR procedure unrelated to principle dx
- 492, 493, 494 Lower ext and humerus procedure, except hip and femur
- 947, 948 Signs and Symptoms
This information can be used by Coding Auditors to target claims for review.
CMS CERT Program: www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring -Programs/Medicare-FFS-Compliance-Programs/CERT/Background