Medicare Compliance & Reimbursement

You have most likely heard the phrase "if it wasn't documented, it wasn't done" so many times that it's old hat -- and yet, insufficient documentation remains one of the biggest denial reasons among Medicare contractors. The OIG tried to improve upon that denial rate by offering practices a second chance to turn in required documentation -- but the majority passed on the offer, leaving contractors no choice but to request a refund of the money that practices had received for those services. Background: When CERT (Comprehensive Error Rate Testing) reviewers find that Medicare paid for claims that are missing documentation, CERT reviewers contact the practices up to three times to request complete documentation to support the claims. In cases when the documentation is not sufficient, the practices have to return the money to the Medicare program. Following a review of the 2010 CERT results, which featured a 10.5 percent error rate [...]