Drug Testing by Independent Clinical Laboratories – CERT Errors

WPS Medicare monitors Comprehensive Error Rate Testing (CERT) findings for provider specialties in order to ascertain emerging error trends for creation of individualized or widespread provider education.  Their analysis of recent findings for Independent Clinical Laboratories reveals high error rates and significant projected improper payments for numerous qualitative drug tests and quantitation of drugs screened (therapeutic drug assays and certain chemistry tests).   The majority of these findings are due to the lack of a valid physician order or documentation of intent and/or missing documentation to support the medical necessity of the service(s) billed. Providers with repeated error findings may be the subject of additional review or educational contacts by WPS Medicare for implementation of corrective actions, or may be referred to other CMS affiliated contractors.

Source: https://www.wpsgha.com