2020 Updated Georgia Comprehensive Error Rate Testing (CERT) Map

The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2020 annual report, here is the CERT information for Georgia hospice providers.

  • Total claims reviewed: 27
  • Total dollars reviewed: $76,144.01
  • Total claims paid: 25
  • Total dollars paid: $67,882.09
  • Total claims denied: 2
  • Total dollars denied: $8,261.92
  • Claims with error code 25 — Medically Unnecessary Service or Treatment: 2

Cert Reviewer Error: 25 — Medically Unnecessary Service or Treatment
The inpatient admission was not reasonable and necessary. Admitted due to lower extremity cellulitis; stable, no fever or leukocytosis. All services could have been provided as outpatient services. Here are some tips to prevent this error:

  • Be sure the medical record documentation supports the services billed according to Medicare guidelines
  • History of patient
  • Progression of illness/disease
  • Recent changes
  • Exacerbation of symptoms
  • Comorbidity
  • Secondary conditions
  • Labs

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