Important CERT Letter Mailed to Providers

Palmetto GBA mailed out an important letter regarding the recent Comprehensive Error Rate Testing (CERT) report to the J1 Part B provider community in April 2011. The soon to be released November 2010 Medicare fee-for-service (FFS) claims error rate will unveil a paid claims error rate result nearly TWICE the national average for services rendered by Part B health care professionals in the J1 region (an approximate 22% error rate for California, Nevada and Hawaii). By far, the major component to the J1 claims paid error rate is the lack of adequate documentation to support services billed. To help lower the paid claims error rate, Palmetto GBA will be undertaking an aggressive approach designed to address the causes of documentation errors. They will increase the level and frequency of pre-payment and post-payment medical review of claims across all provider types and services. They will expand and target their provider outreach and education activities to address the specific elements that their reviews of medical records are finding as lacking in supporting documentation. They will be providing expanded resources and materials via their web activities to help keep you abreast of documentation requirements and highlight the errors being seen in documentation. They will provide the tools necessary to support compliance with the Medicare program coverage and billing requirements, as well as the documentation rules you need to follow to support them. Medicare Part A and Part B MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia. Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada. They are also the Ohio Part B Carrier.