CMS implemented the Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare Fee-for-Service (FFS) program. CERT data analysis, review of claims and medical records, continue to identify a significant increase in pathology and laboratory service errors. Recent errors included insufficient documentation or no documentation in the medical record and incorrect claims coding of services. Specific errors were:
- Documentation did not support reasonable and medically necessary lab services
- No physician order for lab tests or documentation of intent to order the services
- Claims for laboratory services were incorrectly coded
Providers are encouraged to document accurately in the medical record and bill services correctly. If a physician’s order for a diagnostic test is not included in the medical record, the physician must document the intent to order the laboratory service. Documentation must also support the medical necessity of the services.
MAC J10 for Alabama, Georgia, and Tennessee