Corporate

September 30, 2013

Comprehensive Error Rate Testing (CERT) and Physician’s Orders

As part of the process to protect the Medicare Trust Fund, the CERT contractor samples a random number of claims submitted to our office. Physician’s ordering instructions are an important part of the information needed.

An “order” is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. While a physician order is not required to be signed, the physician must clearly document, in the medical record, his or her intent that the test be performed. Keep in mind that while a request to a laboratory does not require a signature, there must be a signature in at least one of two places – either on the office note in which the intent to order the test was clearly documented, or on the requisition or lab order slip.

Documents that may serve as an order or intent:

  • A written and signed document from the treating physician, hand-delivered, faxed or mailed to the testing facility
  • Properly signed progress note indicating reason and test desired
  • Email from treating physician to testing facility requesting test and reason for such. If email used as intent/order the email would need to be properly signed by the requesting physician.
  • Telephone call documented by treating physician and testing facility in the patient’s medical record. If a telephone order is used as intent/order, the phone log/telephone order must be properly signed by the requesting physician.
  • Orders may conditionally request additional or sequential tests if the results of the initial test yields a certain value predetermined by the treating physician.

References:

Definition of an order: CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 15, section 80.6.1External PDF

MLN Matters Article MM6698External PDF - “Signature Guidelines for Medical Review Purposes”


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