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Industry News: CERT

Wednesday, January 27, 2010

The CERT Program calculates the paid claims error rate for Medicare claims submitted to Carriers, Durable Medical Equipment Regional Carriers, and Fiscal Intermediaries. CMS receives in excess of 2 billion claims per year. CERT randomly selects a statistical sample of these claims for review to determine whether the claims were paid properly. The CERT Program uses two contractors to accomplish this work: the CERT Review Contractor and the CERT Documentation Contractor.

Wednesday, January 27, 2010

First Coast Service Options Inc. (FCSO) continues to see a large number of errors identified by the Comprehensive Error Rate Testing (CERT) contractor for clinical laboratory services and diagnostic procedures. The errors are largely due to the absence of a physician's order on file or for failure to provide a copy of the order when documentation is requested. It is inappropriate to bill the Medicare program for clinical laboratory services and diagnostic procedures without a physician's order.

Wednesday, January 27, 2010

Recent Comprehensive Error Rate Testing (CERT) analysis revealed an increase in errors due to incorrect coding for CPT 85025 and 85027.