Hammon Marilyn, Hammon Willy E
University of Oklahoma Health Science Center, Oklahoma City, USA.
J Okla State Med Assoc. 2005 Aug;98(8):401-2.
In order to minimize the risk of submitting improper or false claims, one important component of a compliance program is performing medical chart audits to make certain that all of the essential elements of the billed codes are present in the physician's documentation. The federal government has a program know as the Comprehensive Error Rate Testing (CERT) program which is responsible for auditing the frequency of errors committed by 1) Medicare providers and 2) Medicare carriers and then publishing those results in a report. The CERT report can be a useful guide for auditing charts because it identifies areas that have been particularly problematic and are more likely to be closely scrutinized by governmental auditors.
为了将提交不当或虚假索赔的风险降至最低,合规计划的一个重要组成部分是进行病历审核,以确保计费代码的所有基本要素都出现在医生的文档中。联邦政府有一个名为综合错误率测试(CERT)的计划,该计划负责审计1)医疗保险提供者和2)医疗保险承保机构所犯错误的频率,然后将这些结果发布在一份报告中。CERT报告对于病历审核可能是一个有用的指南,因为它识别出了特别有问题且更有可能受到政府审计人员密切审查的领域。