Common Cert Errors 2010

During the first quarter of 2010, 158 CERT errors were assessed for all Part B contracts within Highmark Medicare Services (HMS). Of those 158 errors, 77 errors were due to insufficient documentation (error code 21), 40 were due to incorrect coding (error code 31), 38 were due to medical necessity (error code 25), and 3 was due to improper documentation submitted to the CERT contractor (error code 16).

 The Part B CERT errors that were received for Highmark Medicare Services during this quarter remain relatively unchanged from the last quarter.

 Error Code 25 – Laboratory and/or diagnostic services did not contain a physician’s order or valid requisition form in the documentation; Services billed were determined to not be medically reasonable and necessary based on the submitted documentation.