2nd Qtr. 2012 CERT Error Summary (Apr. – Jun.)

The below laboratory findings are reported based on the type of documentation, coding, or billing error assessed by the CERT Contractor. WPS Medicare received error findings in the following categories during the second quarter of 2012. Insufficient Documentation – 60% of total errors ï Missing valid physician order or progress note supporting intent for diagnostic services (labs, x-rays) Incorrect Coding – 32% of total errors ï CBC with differential (85025) recoded to CBC without differential (85027) – physician did not indicate differential on order Medically Unnecessary Service or Treatment – 6% of total errors ï Venipuncture which is related to lab services missing a valid order are denied as not medically necessary WPS Medicare: MAC J5 contract, administering Part A and B benefits in Iowa, Kansas, Missouri, and Nebraska

Source: https://www.wpsgha.com