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August 6, 2015

Parenteral Nutrition CERT Errors – Documentation Reminder

Joint DME MAC Publication

A recent examination of CERT reviews for parenteral nutrition claims has identified common errors in the information submitted in support of claims payment. This article will review the findings and related policy requirements.

Reasons for Denial

Statutory coverage requirements not met – 32%

Physician's detailed written order (DWO) not submitted with claim – 16%

Physician's DWO missing detailed item description – 11%

Physician's DWO not signed – 10%

Physician's DWO not dated – 4%

Missing DIF – 16%

Missing documentation – 2%

Missing documentation – 4%

Unsigned Clinical Notes – 2%

Payment Rules

Prescriptions: All items billed to Medicare require a prescription. A detailed written order (DWO) is required before billing. Someone other than the ordering physician may produce the DWO. However, the ordering physician must review the content and sign and date the document. Signature and date stamps are not allowed. Signatures must comply with the CMS signature requirements outlined in PIM 3.3.2.4External PDF.

Documentation

In the event of a claim review:

This article presents a summary of the policy requirements related to the errors identified in a CERT review. The majority of reasons for CERT errors (59%) are completely within the purview of suppliers. Thus, suppliers are encouraged to review their claim submission practices, in order to reduce the high level of CERT errors. Statutory requirements necessary for coverage are not discussed in this article. Please refer to the Parenteral Nutrition LCDExternal website and related Policy articleExternal website for complete information.

Further education regarding this policy is available on your DME MAC Contractor's website.

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