Analysis of Part B CERT Data (July – September 2010)

During the third quarter, 52 CERT errors were assessed for all Part B contracts within J12. Of those 52 errors, 18 errors were due to insufficient documentation, 5 were due to medical necessity and 29 were due to incorrect coding. The majority of the errors for insufficient documentation were related to the fact that the medical record documentation did not contain a valid physician’s signature or the radiology report/diagnostic test did not contain a valid physician order or identification of the provider who rendered the service. Other insufficient documentation errors received consisted of documentation did not adequately describe the service defined by the reported CPT code, HCPCS code, or HCPCS modifier billed. The medical necessity errors consisted mainly of laboratory and/or diagnostic services which did not contain a physician’s order or valid requisition form in the documentation. Please remember when you receive a request for documentation from the CERT contractor, to submit any and all documentation that you have to support the service(s) billed to Medicare. It is important that this information include items such as progress notes, therapy notes, results of diagnostic and/or laboratory tests, AND physician’s orders and signatures. If the documentation is illegible, please provide transcription with your original notes when you send them to the CERT contractor.