A new report by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) says a more vigorous effort by contractors working for the Comprehensive Error Rate Testing (CERT) program to find missing documentation could have cut the payment error rate in the Medicare program by $956 million in 2010.

OIG conducted a pilot project to obtain missing documentation identified in the fiscal year (FY) 2010 CERT program and published the report recently. It is available at http://oig.hhs.gov.

“Based on our results, the CERT statistical contractor estimated that additional documentation to overturn claim payment denials would have reduced the FY 2010 error rate estimate from 10.5 percent to 10.2 percent, which would have reduced the estimate of improper payments by approximately $956 million,” the report said.

OIG obtained additional documentation in its survey project that enabled the CERT review contractor to overturn, or partially overturn, its claim payment denials for 46 of 136 claims, amounting to around 34 percent.

The CERT review contractor overturned its claim payment denials for 46 claims because it determined that the additional medical records OIG obtained were proof enough to show that the health services or items billed to the Medicare program were medically necessary.

The CERT contractor did not initially get the added documentation because it did not always contact referring providers directly to obtain missing information, did not always redirect follow-up documentation requests to compliance or reimbursement personnel, or did not always seek proper signatures on clinicians’ notes when the signatures were  illegible, the report said.

To improve the program, OIG recommended that the Centers for Medicare & Medicaid Services (CMS) continue to educate providers on the issue. It also said CMS should assess the improper payments identified by the CERT review contractor and the overturned denials of claim payments to explore which claims may benefit from a deeper review.

Lastly, the report said, CMS should ensure that the CERT documentation contractor follow established rules in seeking signature attestations.

CMS disagreed with the final two recommendations, noting it has intensified efforts throughout 2011 to improve the claims documentation process and that contractors have been following procedures on signatures.