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Posting Date: 01/29/2021
Hemodialysis Treatment
Hemodialysis Treatment Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]
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Posting Date: 01/29/2021
Psychiatry and Psychology Services
Psychiatry and Psychology Services CERT has determined that insufficient documentation caused improper payments for psychiatry and psychotherapy; insufficient documentation means that information was missing from the medical [...]
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Posting Date: 05/28/2020
Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments
Hospital Discharge Summary: Insufficient Documentation Causes Most Improper Payments Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there [...]
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Posting Date: 01/29/2021
Bill Inpatient or Outpatient Services
Bill Inpatient or Outpatient Services To help avoid denials, National Government Services has compiled information regarding references that will aid in determining whether to bill inpatient or outpatient services. CMS Medicare Learning [...]
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Posting Date: 01/29/2021
Process for Requesting Medical Records
Process for Requesting Medical Records Additional Documentation Requests INITIAL ADR letters for CERT are sent to the address on file with the NSC for DMEPOS suppliers, or the MAC for the provider/supplier that billed/submitted the [...]
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Posting Date: 01/29/2021
Inpatient Psychiatric Certification/Recertification/Delayed Certification
Inpatient Psychiatric Certification/Recertification/Delayed Certification Physicians are required to certify the medical necessity of inpatient services. This is required on admission and if the service is needed for an extended period of [...]
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Posting Date: 01/19/2022
Physician Documentation Requirements for Certification of Home Health Care
Physician Documentation Requirements for Certification of Home Health Care Medicare has changed the physician documentation requirements for certification of home health care for dates of service effective 1/1/2015. While clinicians still need [...]
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Posting Date: 01/29/2021
SNF Inpatient Stays
SNF Inpatient Stays The CERT contractor has seen increased denials of SNF inpatient stays due to missing or incomplete physician certification statement of medical necessity. Certification of medical necessity of inpatient skilled nursing [...]
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Posting Date: 02/12/2016
Physician Orders to Admit to Inpatient Hospital or for Observation Services
Physician Orders to Admit to Inpatient Hospital or for Observation Services Lack of a formal order for inpatient admission or observation services results in an increase of the CERT error rate for National Government Services. CERT auditors [...]
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Posting Date: 01/29/2021
Pacemakers and Cardiac Defibrillators
Pacemakers and Cardiac Defibrillators National Government Services would like to alert providers that although coverage indications of pacemakers and implantable cardiac defibrillators was revised and expanded effective with dates of service [...]
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