E/M services are the most common CERT errors found with Medicare Part B claims. The medical records that were provided either do not support the level of service billed or do not indicate the service was performed. The E/M service is either denied or adjusted to a lower level of service code.
In some situations the billing provider relies on a third party to submit the medical records for certain services (e.g., hospital visits, lab results, physician orders). The CDC either receives incomplete or no medical records, which results in a claim denial or adjustment to match the documentation that was received. The billing provider is solely responsible for submitting all the medical records to the CDC, when a claim has been selected by CERT. All medical records need the CERT barcode as a cover sheet.
Avoid an E/M claim from being denied or adjusted by:
E/M errors can also be avoided if the billing providers do not: