On the November 2005 CERT Error Report, the CERT contractor, AdvanceMed, reported that they selected 27 claims for advanced imaging services. Of those 27 claims, 4 claims were noted to have errors including insufficient documentation and incorrect coding. Here are some documentation submission suggestions based on comments from AdvanceMed.
For imaging services that include the use of contrast, the provider must submit documentation to support that contrast was used by identifying the specific type of contrast and the dosage. An invoice would meet this documentation requirement if it supports the date of service billed.
Documentation submitted must
exactly match the service billed. One error was called on a claim where the provider had billed for a CT scan of the chest but the documentation submitted to AdvanceMed was for a chest X-ray. Another error was called because a provider billed for a CT of the chest
with contrast but the report submitted was for a CT of the chest
without contrast. An overpayment request was done to adjust these claims billed in error meaning that money was recouped from the provider.
Billing documents such as EOBs and intake sheets will not be sufficient documentation for the CERT contractor. If the claim billed is for the professional component of an imaging service, the CERT contractor would expect to see a report with an interpretation of the service that includes the name and signature of the reading/billing provider, the date that the service was rendered and the name of the beneficiary that received the service. If the claim billed is for the technical component of an imaging service, the CERT contractor would expect to see a report describing how the service was performed, the name of the beneficiary that received the service, the date that the service was performed and the name and signature of the performing/billing provider. If the claim billed were for a global service, the CERT contractor would expect to see a combination of the above.
Other helpful CERT tips - All documentation should contain a legible beneficiary name, first and last, the name should exactly match the beneficiary's Medicare card as that is the name that we have in our system.
- All documentation should contain a legible provider signature; if the provider signature is not legible the name should be printed below the signature.
- All documentation should contain the date that the service was rendered.
- It is the responsibility of the billing provider to obtain documentation from other entities to support the services if the billing provider does not keep the documentation on file.