Railroad Medicare: Laboratory Services: Submitting Requested Documentation to the CERT

Railroad Medicare is seeing an increasing volume in laboratory services claims selected by the Comprehensive Error Rate Testing (CERT) contractor for review. The majority of improper payments for laboratory services identified by the CERT are due to insufficient documentation. When completing progress notes, the physician should clearly indicate each specific test to be performed. Documentation in the patient’s medical record must support the medical necessity for ordering the service(s), per Medicare regulations. When you receive a request for records, they may be housed at another location (for example, a nursing facility, hospital, or referring physician office). If the requested documentation is located at another facility, it is the billing provider’s responsibility to obtain the medical records, regardless of where the records are housed. The CERT contractor cannot be referred to a third party to obtain medical records.