2020 Jurisdiction M Part B Virginia Comprehensive Error Rate Testing (CERT)

The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2020 annual report, here is the Jurisdiction M Part B CERT information for Virginia.

  • Total claims reviewed: 10
  • Total dollars reviewed: $1597.94
  • Total claims paid: 9
  • Total paid correctly: $1540.84
  • Total claims denied: 1
  • Total paid incorrectly: $57.10
  • Claim with error code 31 — Incorrect Coding: 1

CERT Error Code 31 — Incorrect Coding
The 31 error code means the documentation submitted for review by the provider does not match the codes billed for the claim. To prevent this error, make sure this documentation is submitted in the record for review.

  • Make sure the date(s) of service are documented
  • Ensure the proper principle diagnosis and principle procedure is coded correctly
  • Include all documentation to support the codes billed
  • Use a checklist to ensure all of the essential pieces are included in the record
  • Make sure that both sides of double-sided documents are submitted
  • Remember it is the billing provider’s responsibility to obtain any necessary information required for the record review, regardless of the location of the documentation

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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