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Documentation Requirements for Comprehensive Error Rate Testing Requests—Oxygen and Oxygen Equipment

Recent documentation reviews on oxygen claims obtained through CERT requests revealed an increased denial rate due to incomplete documentation or documentation not being submitted.

The CERT program is instituted by the CMS. CERT monitors the accuracy of Medicare payments of claims submitted to fiscal intermediaries, carriers, and DME MACs. CERT calculates error rates and estimates improper claim payments using a methodology approved by the OIG.

The CERT review contractor (CRC) reviews documentation to determine medical necessity, to determine services documented in the records are correctly billed, and to determine that units billed are supported in the records. If documentation is not returned, incomplete, insufficient, illegible, or poorly copied, claims could be denied.

Responding to the CERT documentation contractor (CDC) is very important. Compiling documentation for CERT requests is the responsibility of the provider/supplier. If the documentation requested is located at a third party location, such as a physician office, laboratory department, or radiology department, it is the obligation of the provider/supplier to contact that location and request the records that are needed.

An Oxygen and Oxygen Equipment Documentation Checklist is available on the National Government Services Web site to provide guidance to suppliers when compiling the appropriate documentation needed for medical necessity coverage. The Oxygen and Oxygen Equipment Documentation Checklist is available in the Clinical Education section of the Web site.

It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Oxygen and Oxygen Equipment LCD (L27221) and Policy Article. Please ensure when submitting additional documentation requests that all supporting medical necessity documentation is provided and respond in a timely manner. Suppliers can review the Oxygen and Oxygen Equipment LCD on the National Government Services Web site.

Documentation Requirements for Comprehensive Error Rate Testing Requests-Oxygen and Oxygen Equipment
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