Advance Notice To Those Billing Lab Services

The Medicare Comprehensive Error Rate Testing (CERT) contractor’s review of services billed to Medicare for lab services has identified a high claims payment error rate for the claims. As a result Palmetto GBA will soon be doing medical review of these claims and it’s likely that some of your claims will be selected.

The CERT contractor’s denials on lab related claims were mostly for missing orders and missing and/or illegible signatures. As the entity billing to Medicare you are responsible for having the physicians’ orders, hardcopy or verbal, available to be reviewed when requested by Medicare’s contractors. Failure on your part to produce the necessary orders and signatures will likely result in a denial of the claim. Please be sure you have procedures in place to be able to provide the requested documentation.