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Printed Date: 9/22/2015
The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2018 annual report, here is the Part B CERT information for Georgia:
Cert Reviewer Error: 21 — Insufficient Documentation
Missing the following documentation: Pre-Operative History and Physical specifics as related to bilateral knees prior to surgery such as conservative treatment completed, injections, physical therapy; pain medications and pre-operative X-rays showing specific osteoarthritic changes such as joint space narrowing, osteophytes, sclerosis, etc., or bone-on-bone process. The documentation is insufficient to support services as billed.
Tips to Avoid Error 21:
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.
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Last Updated: 03/08/2019