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Posting Date: 11/15/2024
Revalidate My Enrollment
Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]
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Posting Date: 11/15/2024
Revalidate My Enrollment
Step 1: Determine You Are in the Right Place Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401(a), which established a requirement for all enrolled providers/suppliers to [...]
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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 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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Posting Date: 03/30/2020
Chiropractic Services
Chiropractic 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: 05/18/2020
Amending Medical Records
Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]
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Posting Date: 12/17/2019
Continuous Cycling Peritoneal Dialysis
Continuous Cycling Peritoneal Dialysis 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 [...]
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Posting Date: 11/01/2019
Cologuard TM Multitarget Stool DNA Test
CologuardTM Multitarget Stool DNA Test 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 [...]
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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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Posting Date: 11/14/2024
MLN Connects® Newsletter: November 14, 2024
MLN Connects® Newsletter: November 14, 2024 News 2025 Medicare Parts A & B Premiums and Deductibles Medicare Participation for CY 2025 Ambulance Fee Schedule: CY 2025 Final Policies Prior Authorization Review Timeframe Change [...]
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Posting Date: 11/14/2024
November 21st is The Great American Smokeout
November 21st is The Great American Smokeout You Can Help Your Patients Quit Smoking Smoking is one of the leading causes of heart disease and stroke. At least 70% of cigarette smokers see a clinician annually and many want to quit. Each [...]
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Posting Date: 11/14/2024
Part B Claims Denied with Error 524B
An error in CWF processing has not yet been fully corrected. The error is occurring when Demo Codes A5 (Making Care Primary-MCP) or A6 (Guiding an Improved Dementia Experience-GUIDE) are on the claim and the HIC on the claim has an active MSP [...]
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