OIG to CMS: Review oversight process for CERT

Monday, January 20, 2014

BALTIMORE – The error rate reduction plans of Medicare claims administrator contractors are not always relevant to CERT results and vary substantially in number, according to a new report from the Office of Inspector General (OIG). CMS oversight of error rate reduction plans is limited and the staff that reviewed the plans may have been unable to determine whether the plans addressed their most recent CERT results, the OIG found. “Additionally, although some of the sampled plans did not include the five required elements or were for contracts with high error rates, CMS approved all sampled plans without recommending different or additional corrective actions,” the OIG stated. The OIG recommends CMS review its oversight process, ensure contractors submit clear error-reduction plans, provide more guidance for those who review the plans, and provide incentives aligned with error rates and performance periods. CMS agreed with the recommendations.