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Posting Date: 11/08/2019
Prothrombin Time
Prothrombin Time We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper [...]
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Posting Date: 10/15/2019
Diagnostic Mammography
Diagnostic Mammography 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: 09/20/2019
Prolonged Services
Prolonged 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: 06/27/2019
Annual Wellness Visit
Annual Wellness Visit 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 an [...]
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Posting Date: 01/29/2021
Hyperbaric Oxygen Therapy Treatment
Hyperbaric Oxygen Therapy Treatment Insufficient documentation is documentation that was incomplete, inaccurate or was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient [...]
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Posting Date: 01/29/2021
Surgery Services
Surgery Services 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
Medication Administration
Medication Administration Insufficient documentation means 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
Ambulance Services
Ambulance Services 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
Stereotactic Body Radiation Therapy
Stereotactic Body Radiation Therapy Insufficient documentation means that something was missing from the medical records. Below are the most common reasons CERT determined there was insufficient documentation that caused improper payments for [...]
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Posting Date: 01/29/2021
Anesthesia Services
Anesthesia Services Insufficient documentation means 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
Diagnostic Testing Services
Diagnostic Testing Services Insufficient documentation means 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
Transcatheter Aortic Valve Replacement
Transcatheter Aortic Valve Replacement The CMS CERT program produces a national Medicare FFS error rate, as required by the Improper Payments Information Act. CMS strives to eliminate improper payments in the Medicare Program to maintain the [...]
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Posting Date: 01/29/2021
Part A to Part B Claims (Rebilling) Submissions
Submitting Part A to Part B Claims (Rebilling) Submissions Administrator’s Ruling CMS 1455-R The Administrator’s Ruling CMS 1455-R, issued on 3/13/2013 established an interim process for hospitals to use to submit claims for Part B [...]
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Posting Date: 01/29/2021
Inpatient Hospital Surgery
Inpatient Hospital Surgery National Government Services would like to alert providers on one of the highest dollar and most avoidable denials from the CERT contractor: submitting documentation relating to inpatient hospital surgeries. [...]
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Posting Date: 01/29/2021
Redetermination/Reopening Requests Online with NGSConnex
Redetermination/Reopening Requests Online with NGSConnex The NGSConnex web application allows providers/suppliers the ability to electronically submit and check the status of all redeterminations and/or reopenings requests online with no costs [...]
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Posting Date: 10/07/2010
Selecting the Appropriate Principal Diagnosis for Inpatient Services
Selecting the Appropriate Principal Diagnosis for Inpatient Services CERT analysis indicates providers are not coding the principal diagnosis to the highest level of specificity and/or selecting the most appropriate code for the inpatient [...]
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Posting Date: 01/29/2021
Complete Blood Count with Differential CPT Code 85025
Complete Blood Count with Differential CPT Code 85025 Error code 31 services incorrectly coded have been increasing in relation to CPT code 85025 - Complete blood count with differential (CBC w/Diff). Review of the CERT data shows that the [...]
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Posting Date: 01/29/2021
Evaluation and Management Codes
Evaluation and Management Codes E/M services are the most common CERT errors found with Medicare Part B claims. The medical records that were provided either do not support the level of service billed or do not indicate the service was [...]
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Posting Date: 01/29/2021
Diagnosis-Related Group Claims Reviewed for IPPS Providers
Diagnosis-Related Group Claims Reviewed for IPPS Providers This notice is intended to educate IPPS providers on the CERT program findings for DRG claims reviewed. Trending analysis disclose that the top errors are related to medical necessity [...]
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Posting Date: 10/07/2010
Therapy Checklist
Therapy Checklist National Government Services would like to thank all providers for their cooperation in providing requested medical records to the CDC. We at NGS appreciate your effort and encourage your continued assistance in the program. [...]
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