Search the Medicare Fee-for-Service Comprehensive Error Rate Testing API
Source:R/codex_cert.R
codex_cert.RdInformation on Medicare Fee-for-Service (FFS) claims that underwent Comprehensive Error Rate Testing (CERT) medical review. These claims were used to calculate the Medicare FFS improper payment rate.
Usage
codex_cert(
year = 2021,
part = NULL,
drg = NULL,
hcpcs = NULL,
prov_type = NULL,
bill_type = NULL,
decision = NULL,
error = NULL,
clean_names = TRUE,
lowercase = TRUE
)Arguments
- year
YYYY, calendar year of CERT data. 2011-2021 data is currently available.
- part
Type of Medicare Fee-for-Service claim
- drg
The Diagnosis Related Group code
- hcpcs
The Healthcare Common Procedure Coding System code
- prov_type
Type of provider providing the service
- bill_type
Type of Bill (TOB), Identifies type of facility, type of care, and sequence of bill in a particular episode of care; e.g. "721", "131", "110", "111"
- decision
Medical review decision for the claim; either
AgreeorDisagree- error
Reason the claim was in error; e.g. "Insufficient Documentation", "Incorrect Coding"
- clean_names
Clean column names with janitor's
clean_names()function; default isTRUE.- lowercase
Convert column names to lowercase; default is
TRUE.
Value
A tibble containing the search results.
Details
The Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) dataset provides information on a random sample of FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules. The dataset contains information on type of FFS claim, Diagnosis Related Group (DRG) and Healthcare Common Procedure Coding System (HCPCS) codes, provider type, type of bill, review decision, and error code. Please note, each reporting year contains claims submitted July 1 two years before the report through June 30 one year before the report. For example, the 2021 data contains claims submitted July 1, 2019 through June 30, 2020.