Requested CERT Documentation Located at Another Facility

Published 06/06/2021

If the requested CERT documentation is located at another facility (e.g., hospital, nursing home, referring physician's office, etc.) as the billing provider, it is your responsibility to obtain the medical records to support services billed to Medicare, regardless of where the records are housed. The CERT contractor should not be referred to a third party to obtain medical records.

Diagnostic Test Order Needed to Support a Service for the Interpretation of a Diagnostic Test
Providers billing for only the interpretation of a diagnostic test (diagnostic X-rays, laboratory tests and other diagnostic tests furnished), must, when requested, submit documentation to support the order and medical necessity of the test. This may require that the performing provider obtain a copy of the order or authenticated (signed) medical records from the ordering provider or the provider that referred the test for interpretation. Failure to provide this information when requested will result in your claim being denied and collection of any overpayment.

Orders for Tests Must Be Signed
If an order for tests is unsigned, you may submit progress notes showing intent to order the tests. The progress notes must specify what tests were ordered. A note stating “Ordering Lab” is not sufficient. If the orders and the progress notes are unsigned, your facility will be assessed an error, which may involve recoupment of an overpayment. Please refer to Medicare Program Integrity Manual 100-08, Chapter 3, Section - Signature Requirements (PDF).

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