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Posting Date: 11/14/2024
Deactivation of Billing Privileges/Suspension of Payment
Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]
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Posting Date: 11/14/2024
Deactivation of Billing Privileges/Suspension of Payment
Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information [Return to [...]
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Posting Date: 11/14/2024
Complying with the Comprehensive Error Rate Testing Program
Do you know who the Comprehensive Error Rate Testing (CERT) contractor is? Have you been notified of CERT record requests and/or received CERT claim errors? The Centers for Medicare & Medicaid Services (CMS) established the CERT program to [...]
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Posting Date: 11/14/2024
The “How To” in Avoiding Documentation-Related Claim Denials
Have you received claim denials for missing or incomplete documentation? Does your facility have difficulty responding timely to our additional development requests (ADRs)? Join us for a session that will focus on tips to prevent and [...]
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Posting Date: 11/14/2024
Understanding Your Medicare Secondary Payer Responsibilities
All Medicare providers have responsibilities related to Medicare being the secondary payer including identifying payers primary to Medicare (per the Medicare Secondary Payer provisions, such as Employer Group Health Plans, No-Fault, WC, etc.), [...]
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Posting Date: 11/14/2024
Let’s Get Familiar with National Correct Coding Initiatives Procedures
The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) program to promote national correct coding. Incorrect coding often leads to improper payment and increases the paid claims error rate. If [...]
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Posting Date: 11/15/2024
Revalidate My Enrollment
Table of Contents Step 1: Determine You Are in the Right Place What’s ahead for your next Medicare enrollment revalidation? How will you know if you are due for revalidation? Step 2: Complete the Medicare Application Step 3: [...]
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Posting Date: 01/21/2021
No Documentation Received
No Documentation Received National Government Services has experienced an increasing number of CERT errors due to “no documentation” received. The provider either does not respond to the CERT documentation request letter(s), or the provider [...]
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Posting Date: 09/20/2019
Signature Requirements
Signature Requirements National Government Services has experienced an increasing number of CERT errors due to “signature requirements” not being met. Providers are not signing orders, certification/recertification forms or office visit notes. [...]
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Posting Date: 01/29/2021
Appeals Process after Claims Correction or Denial
Appeals Process after Claims Correction or Denial CERT Process The CERT contractor randomly selects claims submitted to Medicare. Medical records are requested from the providers and then reviewed by health care professionals. The review is [...]
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Posting Date: 09/20/2022
Physical Therapy Services
Physical Therapy Services Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]
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Posting Date: 05/18/2020
Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management
Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. [...]
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Posting Date: 08/23/2021
Psychological and Neuropsychological Testing
Psychological and Neuropsychological Testing 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 [...]
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Posting Date: 05/11/2021
Pulmonary Rehabilitation Program Services
Pulmonary Rehabilitation Program Services 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 [...]
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Posting Date: 11/04/2020
Patient Discharge Disposition Code
Patient Discharge Disposition Code Improper payments due to discharge disposition codes are costly to the Medicare Program and are easily preventable. The CERT contractor has issued errors related to the discharge disposition codes that may [...]
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Posting Date: 09/29/2020
Debridement Services
Debridement Services 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 was [...]
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Posting Date: 09/24/2020
Chronic Care Management
Chronic Care Management 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 was [...]
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Posting Date: 07/09/2020
Total Joint Arthroplasty
Total Joint Arthroplasty Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Providers can help prevent CERT errors on total joint arthroplasty by [...]
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Posting Date: 05/12/2020
Botulinum Toxin Injections for Chronic Headaches
Botulinum Toxin Injections for Chronic Headaches 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 [...]
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Posting Date: 05/05/2020
Home Health Care Requirements for a Plan of Care
Home Health Care Requirements for a Plan of Care The HHA must be acting upon a physician plan of care that meets the requirements of this section for HHA services to be covered. For HHA services to be covered, the individualized plan of care [...]
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