Top CERT Errors

Published 04/25/2019

Avoid Coding Errors
When submitting your claims to Medicare for processing, please ensure the codes on the claim match the documentation that is in the medical records. 

Common Error
Billing for the wrong date of service or with the incorrect code.

Please see CERT Error: Incorrect Coding for guidance.

Transitional Care Management
It is important to bill for the date the patient was seen. Waiting until day 30 is not appropriate to use as that is not the correct date of service.

Common Errors

  • Billing for the actual date performed instead of billing on the date that is required to bill
  • Provider waiting until day 30 to bill and using day 30 as the billing date instead of the date the patient was actually seen
  • Missing documentation to support there was some sort of contact with the patient within two business days of discharge from the inpatient hospital addressing patient status to support the billed transitional care management services

For additional information on billing and documentation requirements, please refer to
Transitional Care Management.

Psychiatric Admission
The initial psychiatric evaluation with medical history and physical examination must be performed within 24 hours of admission in order to establish medical necessity for psychiatric inpatient hospitalization services.

Common Error
Missing the physician-signed multidisciplinary treatment plan.

For additional information on psychiatric admission, please refer to the Inpatient Psychiatric Facility Webcast  for more information.

Skilled Nursing Facility Certifications and Recertifications
Skilled Nursing Facilities are expected to obtain timely certification and recertifications. Each certification must contain all pertinent information.

Common Error
Missing required contents on the Certification and Recertification.

Please refer to SNF Services for further assistance.

Providers should not add a late signature to the medical record (beyond the short delay that occurs during the transcription process). Medical records must be signed prior to their submission to CERT. In many cases, when the signature is missing from the original medical record submission, the provider then submits an appeal with a copy of the medical record signed after the CERT review. This documentation is unacceptable and Palmetto GBA will contact the provider asking for an attestation statement.

Common Errors

  • Providers are not sure what this is or what is required
  • Providers are altering the documentation and submitting documentation with signatures after the initial documentation was sent to CERT with a missing signature

Please review Physician Signatures for further assistance and guidance.

End Stage Renal Disease (ESRD)
The ESRD PPS includes consolidated billing requirements for limited Part B services included in the ESRD facility’s bundled payment. CMS periodically updates the lists of items and services that are subject to Part B consolidated billing and are therefore no longer separately payable when provided to ESRD beneficiaries by providers other than ESRD facilities.

Common Error
Providers are not submitting orders for dialysis.

Please review ESRD Billing and ESRD Payment for further assistance.

Was this article helpful?