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 diagnostic testing services.
Physician order or intent to order: The physician who is treating the beneficiary must order all the diagnostic tests. The treating physician is a physician who furnishes the consultation or treats the beneficiary for a specific medical problem and uses the results in the management of the specific medical problem. The progress notes should clearly indicate all tests to be performed. The documentation to support the intent to order would be a signed progress note, signed office visit note, or signed physician order.
Medical necessity: Documentation in the patient’s medical record must support the medical necessity for ordering the diagnostic service per Medicare regulation and applicable national coverage determinations (NCD).
Keep these medical records available upon request:
- Progress notes or office notes
- Physician’s order/intent to order
- Diagnostic test results
- Attestation/signature log for illegible signature
Related Content
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 110 - Provider Retention of Health Insurance Records (1.70 MB)
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.6.2.2 - Reasonable and Necessary Criteria (607 KB)
Reviewed 11/14/2024
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found atwww.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found at www.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found at www.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found at www.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction