2020 Updated Alabama 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 Alabama hospice providers.

  • Total claims reviewed: 31
  • Total dollars reviewed: $96,879.14
  • Total claims paid: 30
  • Total dollars paid: $96,870.46
  • Total claims denied: 1
  • Total dollars denied: $8.68
  • Claims with error code 21 — Insufficient Documentation: 17

CERT Reviewer Error: 21 — Insufficient Documentation
When a provider receives a Comprehensive Error Rate Testing (CERT) error for insufficient documentation, it means that elements of the medical record that are imperative for Medicare payment are missing from the medical record sent in to the CERT contractor for review. Here are some tips to prevent this error:

  • Remember it is the billing provider’s responsibility to obtain and necessary information required for the record review, regardless of the location of the documentation
  • Make sure that both sides of double sided documents are submitted
  • Ensure the documentation has legible signatures and dates
  • Ensure the correct CPT/HCPCS code is used, if applicable
  • Ensure physician orders and documents the interventions were performed
  • Include test results and lab results, if applicable
  • Make sure the copy sent to the CERT contractor is legible
  • Number the pages before making a copy, so it will be easy to see if one of the pages are missing
  • Use a checklist to ensure all of the essential pieces are included in the record

Contact Palmetto GBA JM Part HHH Medicare

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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