Reduce the CERT Error Rate: Avoid These Common Errors
CGS Provider Education is committed to helping suppliers avoid claim denials and overpayments from Comprehensive Error Rate Testing (CERT) reviews.
CGS Operation: Reduce the Error Rate is an innovative approach to eradicate common CERT errors, through data analysis and education.
We created this page to help you avoid common documentation and billing errors. We will update this page with more tips as we find additional issues.
Tip #1: Proof of Delivery for Shipped Items
Top reason for proof of delivery errors: Delivery via Shipping or Delivery Service Directly to a Beneficiary (Method 2) – The supplier's detailed shipping invoice is missing the delivery service's tracking information.
If you deliver using a shipping service or mail order, keep a complete record tracking the items from you to the beneficiary.
Here are tips to help you avoid an error:
- Include both your detailed shipping invoice and the delivery service's tracking information.
- Link your record to the delivery service record by some clear method like the delivery service's package identification number or your invoice number for the package sent to the beneficiary.
- Proof of delivery documentation requirements:
- Education: Visit the Calendar of Events and register for the next Documentation Requirements: Use & Need, Refill and Proof of Delivery webinar.
Tip #2: Ordering Practitioner's National Provider Identifier (NPI)
Frequent claim submission error: The name and NPI of the ordering practitioner on the claim does not match the name of the practitioner who completed the order.
When patients are under the care of more than one practitioner, we encourage you to check the name of the practitioner who signed the order. Make sure the information on the claim matches the order.
Tip #3: Insufficient Documentation
Most errors are due to insufficient documentation. To avoid these types of errors, be sure to send all information to support the services billed. The CERT request includes a checklist of what you need to send.
It is the supplier’s responsibility to gather any supporting documentation from third parties such as treating/ordering practitioners, hospitals, labs, and skilled nursing facilities. Suppliers must also have documentation such as proof of delivery and request for refills.
Set up a process to:
- Make sure all records are legible. If you cannot read it, then a reviewer will not be able to read it either.
- Create a consistent intake procedure for each beneficiary. Get all the information Medicare needs to support your claim.
- Check your documentation. Does it meet all the requirements? CGS created documentation checklists to help you be compliant.
- Avoid an overpayment. Send documentation to the CERT Documentation Center Contractor by the due date.
- Organize your response. Use the bar-coded sheet from CERT as the cover letter for your documents.
Published: 05.06.24