WPS 4th Qtr. 2014 (Oct. – Dec.) – CERT Error Summary-Labs

Comprehensive Error Rate Testing (CERT) findings are reported based on the type of documentation, coding, or billing errors that are assessed by the CERT Contractor. WPS Medicare received error findings for J5 providers in the following categories during the fourth quarter of 2014.

• Insufficient Documentation – 76% of total errors- Missing the treating physician’s order or clinical documentation to support the plan or intent to order the specific tests and the medical necessity for the tests.
• Incorrect Coding – 18% of total errors- wrong CPT code billed based on test ordered
• Medically Unnecessary Service or Treatment – 1.5% of total errors- Medicare regulations state services related to non-covered services are not reasonable or necessary.