National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Comprehensive Error Rate Testing (CERT) Alert: December 2007

National Government Services would like to thank all providers for their cooperation in providing requested medical records to the Comprehensive Error Rate Testing Documentation Center (CDC). We at National Government Services appreciate all of the dedication applied to the requests and want to continue to encourage your assistance in the program.

To improve the records that are received by the CDC, National Government Services would like to offer some additional information to help decrease denials for insufficient documentation. With your help we can strive to decrease the insufficient documentation errors even further.

Review of May 2007 CERT report shows that denials are occurring, not because CDC is not getting the records, but because the records sent are missing critical information.

The highest dollars denied by provider type billing to fiscal intermediaries (FI) is outpatient prospective payment system (OPPS), laboratories, and ambulatory services. In the May 2007 report this group of provider types together had $384,307,290 dollars paid in error, and the biggest reason for the denials was insufficient documentation at 45.2 percent.

Providers are submitting orders for the lab work or diagnostic tests, but the documentation submitted does not include the results of the lab and/or diagnostic test. The CDC needs to have documentation to show that the service was actually completed, not just ordered by the physician.

To help decrease the dollars in error we are asking that providers who bill labs and/or diagnostic tests please make sure to submit the results of those tests when submitting records, along with the physician order and the diagnoses to support medical necessity. This will help to decrease dollars paid in error. National Government Services is asking providers to also remember when supplying documentation, to verify that the records you provide are for the correct beneficiary, correct date of service, and the correct service.

For example, if you are billing for a Prothrombin test (PT) on November 2, 2007, please make sure that you send the physician order with diagnoses, the lab result, and verify that the lab was performed on the date you billed.

With your continued support of the CERT program we can help decrease the national paid dollars in error.

Thank You,
National Government Services