Skip to Main Content

Print | Bookmark | Email | Font Size: + |

Reduce the CERT Error Rate: Avoid These Common Errors

CGS Operation: Reduce the Error Rate

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:

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.

Tip #4: Incorrect Coding

Documentation must accurately support the claim and services billed.

An error for incorrect coding could mean one of the following:

  • Documentation supports either a different code or different number of services.
  • A modifier is either missing or used improperly.
  • The date of service billed does not reflect the date of delivery.

Help Us Help You!

It is a combined effort between the CERT contractor, CGS, and DMEPOS suppliers to reduce the error rate.

CGS offers a variety of educational resources to help suppliers stay compliant.

  • Medical Review Education Programs
    • CGS Connect Program: This is a unique service for suppliers seeking professional review and evaluation of pre-claim documentation before submitting a claim to Medicare.
    • Provider 360: This program helps suppliers reduce or stop claim denials and errors by way of "lean" education.
  • Online Education Portal
    • These online courses are great training tools for new staff as well as seasoned suppliers to brush up on Medicare knowledge. The best part of online education courses is that they are available 24 hours a day 7 days a week!
  • DME Provider Outreach & Education: Calendar of Events
    • Includes listings of policy-based and general topic webinars associated with the Medicare program, such as Documentation Requirements, Prior Authorization, Self-Service Tools and much more!
  • Video Education
    • Have a minute? That's all it takes to listen to video education from the CGS Medical Directors.

Revised: June 24, 2024


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved