In the May 2006 Comprehensive Error Rate Testing (CERT) report the CERT contractor, AdvanceMed, reported a 1.7 % paid claims error rate for major procedures ' other BETOS (Berenson Eggers type of Service) category P1G, Major procedures, other, for all carriers in the nation. CERT projected the national dollars paid incorrectly amount to be $14,688,660.00. The latest data available for South Carolina comes from the November 2005 report with an error rate of 22.77%, which is significantly higher than the national error rate. The specialty with the most errors was general surgery.
Providers can help the CERT documentation contractor (CDC) by following these instructions carefully:
- CDC's preferred method for receipt of medical records is via fax.
- When sending records to CDC, via fax or by mail, providers should always place the correct bar coded cover sheet in front of the corresponding medical record.
- Include the CID number on the second line of the CDC address on the envelope, as indicated on the instruction sheet.
- When responding to a Tech Stop or OIG letter, the provider should place the appropriate bar coded cover sheet in front of the record. This will help expedite processing of the records received close to the due date.
- Do not include photocopies of invoices for the cost of providing medical records when responding to requests. The government does not pay these invoices.
- Send the specific documents listed on the Bar Coded Cover Sheet to support the services of each claim identified on the Medical Records/Documentation Pull List.
- Make sure all pages are complete, legible and if two sided, both sides of the document should be copied/faxed to the CDC.
- Do not fax carbon copies of records because the do not transmit as clear documents. Photocopy the document and then send the photocopy via fax.
Effective November 1, 2006 providers will be asked to submit their medical record documentation in accordance with a new time schedule for CDC calls and Medical Request Letters as below:
Day 0 Initial Call/Letter
Day 30 Second Call/Letter
Day 45 Third Call/Letter
Day 60 OIG Letter
Day 76 Claim scored in error
All documentation to support services billed should be sent to AdvanceMed or the CERT documentation contractor
immediately upon request to avoid an overpayment. We suggest that you designate one person in your office to handle all requests from AdvanceMed.