CERT AUDIT

These attachments from Palmetto - California, Nevada and Hawaii - Medicare contractor are important for any urologist faced with a CERT audit or challenged by other Medicare auditors.

Jeffrey Kaufman, MD

These attachments from Palmetto, California, Nevada and Hawaii Medicare contractor are important for any urologist faced with a CERT audit or challenged by other Medicare auditors. There is no amount of money in dispute too small to ignore since the extrapolation policy of Medicare allows them to find a $2 mistake and then multiply it 1000 times based on frequency of charges resulting in a serious payback demand. Moreover, the CERT process (random reviews of charges and payments) often results in Medicare identifying patterns of abuse or errors that then form the basis for more focused reviews of individuals or groups (such as a RAC audit). Because these focused audits are so time consuming and potentially expensive, they should be avoided. This can be done by any reviewed doctor challenging allegations they billed incorrectly whenever the data supports their position (assuming the doctor documents his patient care properly in his chart). It is far less onerous to spend the time and effort appealing early reviews than trying to halt or defend later more aggressive audits. The attachments below are intended for use by anyone audited by the Medicare carrier, CERT contractor or other program integrity reviewer.

What You Don’t Know About A CERT Claim Review That May Have Consequences For You And Your Peers

Part A ADR Response Cover Sheet

Part B ADR Response Cover Sheet

Important Instructions for Those Providers Responding To Palmetto GBA Part A Medical Review Additional Development Requests

Important Instructions for Those Providers Responding To Palmetto GBA Part B Medical Review Additional Development Requests