CERT Error Summary /April 2011 – June 2011

The below findings are reported based on the type of documentation or coding error assessed by the CERT Contractor. WPS Medicare received error findings in the following categories during the second quarter of 2011. Insufficient Documentation – 65% of total errors Reasons for Errors: • Missing valid physician order or notes documenting intent for diagnostic services • Illegible or missing provider signature on physician order or progress notes Medically Unnecessary Service or Treatment – 5% of total errors Reasons for Errors: • Blood draw denied as related to labs that were missing a valid physician order or progress note supporting intent Clinical Laboratory – Specialty 69/CERT Error Examples by Denial Reason 75.28% error rate due to Insufficient Documentation 17.90% error rate due to Medically Unnecessary Services or Treatment 6.83% error rate due to Service Incorrectly Coded

Source: https://www.wpsgha.com