assist you in understanding the reason for the error . The CERT Coordinator may also offer suggestions for next steps to correct the error through the Appeals process .
Listed below are some of the most common errors received and tips on what you can do to prevent errors .
INSUFFICIENT OR OUTDATED DOCUMENTATION AND MEDICAL RECORDS :
Submit current patient records and medical documentation that supports the item billed .
Submit patient records that support the medical necessity criteria of the LCD and Policy Article for the item billed .
Not responding to requests for documentation and medical records will result in a claim error and subsequent request for overpayment recoupment .
NON-RESPONSE FOR ADDITIONAL DOCUMENTATION :
Read the request for additional documentation carefully .
Respond quickly with the requested documentation to avoid possible recoupment actions .
INCOMPLETE OR MISSING ORDERS :
Ensure orders are legible , contain appropriate signatures , and required data elements .
Change in orders must be substantiated by documentation in patient records .
KEEP IN MIND :
Claims that have gone through the Prior Authorization process are still subject to a CERT audit .
Respond quickly with the requested documentation to avoid possible recoupment actions .
Claims that were billed in error and audited by the CERT contractor cannot be corrected by the CERT contractor .
Refund CGS for the claim billed in error .
Do not alter any documentation : this includes hi-lighting , circling , or underlining information in the documentation provided to the CERT contractor . Changes to medical records must be made by the author / originator of the record and must be :
Clearly and permanently identify any alteration or addition .
Clearly indicate the date and author of any alteration or addition .
Preserve the legibility of the original by means of a single , narrow line made through any deletion .
Documentation must be legible . If you can ' t read it , then chances are no one else can . Before faxing , ensure everything requested by the CERT contractor is included and that the documents are fed into your fax machine correctly so they do not get cut off . Check your transmission to make sure that all pages transmitted , if they did not , re-transmit .
48 Pedorthic Footcare Association www . pedorthics . org