Mississippi Hospice CERT Data

  • The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2018 annual report, here is the hospice CERT information for Mississippi.
  • Total claims reviewed: 5
  • Total dollars reviewed: $13,622.56
  • Claims paid: 4 
  • Dollars paid: $9,831.98
  • Claims denied: 1
  • Dollars denied : $3,790.58
  • Claims with error code Insufficient Documentation (21): 1

CERT Reviewer Error: 21 — Insufficient Documentation
Error Subcategory Details:

  • SO — Hospice — Plan of Care: IDT note for last meeting in July or documentation of collaboration with physician for POC update was missing.
  • SQ — Hospice — MD Certification/Recertification: Valid initial certification for benefit period 07/08/XX -10/5/XX was missing.
  • SR — Hospice — Initial Hospice Assessment: Initial and comprehensive assessment was missing.

Here are some tips to prevent this error:

1. Make sure the following information is submitted in the record for review:

  • Hospice election information
  • Identification of the particular hospice that will provide care to the individual
  • The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment
  • The individual’s or representative’s (as applicable) acknowledgment that the individual understands that certain Medicare services are waived by the election
  • The effective date of the election
  • The signature of the individual or representative
  • The plan of care (POC), which is reviewed, revised and documented as frequently as the beneficiary's condition requires, but no less frequently than every fifteen (15) calendar days

2. Comprehensive assessment:

  • Physician Certification
  • Signed and dated
  • Reference to the benefit period
  • Verbal certification included, if applicable
  • Documentation that medical director is the attending, if applicable
  • Narrative/face-to-face encounter narrative
  • Documentation of clinical findings
  • Attestation

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 


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