CERT Tips on How to Avoid Errors
Services Incorrectly Coded
- Primarily due to Evaluation & Management visits billed at levels not supported by the medical records
- To avoid a "service incorrectly coded" error, providers should ensure they are billing the appropriate code for the service being billed. Providers are encouraged to conduct self audits to identify coverage and coding errors.
- For determining the appropriate E&M code, providers are encouraged to review CIGNA Government Services web-based training courses (a series of 3) on Evaluation & Management visits (located under CERT Web Training).
Lack of Documentation
- Primarily due to no response to CERT by provider
- To avoid a "lack of documentation" error providers should provide the exact documentation requested by CERT to support the services billed and paid. Any difficulty procuring the information from a third-party source such as a hospital or skilled nursing facility does not exempt the provider from having to submit the information. Furthermore, faxing the documentation to CERT is the preferred method of submission. You know that CERT has successfully received your fax when you receive a faxed confirmation back from them.
Insufficient Documentation
- Primarily due to the provider submitting the wrong or incomplete information to CERT
- To avoid an "insufficient documentation" error providers should ensure they are submitting the correct and complete set of documentation to support the service for which they have been paid.
Lack of Medical Necessity
- Services did not appear medically necessary according to the medical records submitted
Services not Performed
- Primarily due to incorrect dates of service
- To avoid a "services not performed" error providers should ensure they are submitted claims with the correct date of service and documenting the correct date of service in their notes.
