Of 200 claims sampled in the Aug. 31, 2009, Comprehensive Error Rate Testing (CERT) Feedback Report, 136 errors were identified. A summary of these errors follows .
| Aug. 31, 2009, CERT Errors |
No. of Errors
|
Percentage
|
| Medically unnecessary |
66
|
48.53%
|
| Insufficient documentation |
50
|
36.76%
|
| Service incorrectly coded |
18
|
13.24%
|
| Wrong diagnosis-related group code |
2
|
1.47%
|
Total
|
136
|
100%
|
| Breakdown of Insufficient Documentation |
No. of Errors
|
Percentage
|
Illegible, stamped, typed, altered, or missing
identity of provider |
34
|
68%
|
| Missing lab results |
8
|
16%
|
| Other, dosage |
5
|
10%
|
| Missing hospital chart records |
1
|
2%
|
| Missing valid physician order |
1
|
2%
|
Valid ICD-9-CM code alone was
insufficient information |
1
|
2%
|
| Total |
50
|
100%
|
Nearly half of errors identified in the report were a result of a lack of documentation of medical necessity. More than 36 percent were a result of insufficient documentation. Of that 36 percent, approximately two-thirds were due to failure to meet signature requirements.
Recommendations for improvement:
- Ensure your documentation is complete and supports the service provided.
- Code correctly the first time.
- Respond in a timely manner to requests for documentation.
- Submit complete, legible documentation.
- Be sure to include an electronic or handwritten signature for services ordered and provided.
Refer to the CMS Program Integrity Manual ( PDF ), Chapter 3, Section 3.4.1.1, for information regarding documentation and signature requirements. Additional information about CERT is available on the CERT Web page . Claims identified by CERT as incorrectly paid may result in an overpayment.