Inquiries and Solutions - JE Part B

Q1. What do the letters from the CERT look like?
A1. There are several documentation request letters that your facility may receive from the CERT contractor. If your facility does not respond to the initial letter within 30 days, CERT contractor will send a second letter. A third letter will be sent out 45 days after the initial letter, the final letter is sent 60 days after the initial letter, and recovery of money will be at day 76.

Q2. I am not receiving CERT requests. Where are these letters going?
A2. For more information used by CERT for documentation requests: Check out the Provider Mailing Addresses and Points of Contact for CERT Requests page.

Q3. What can providers do if they have lost records due to flooding, etc.?
A3. Providers may obtain a Disaster Attestation Form from the CERT Provider website. After validation of the facts, the claim is pulled from the sample and another claim is selected as a replacement.

Q4. If providers make an address update on the CERT Provider web site, do they have to Contact Noridian as well?
A4. Yes; the CERT Provider website is for CERT only. Noridian will also have to update the correct address information. This will only update their CERT address. Other address updates would need to be made through enrollment.

Q5. Who receives and processes CERT appeals?
A5. Noridian receives all CERT appeals. The CERT appeals follow the same process as regular appeals.

Q6. Does a physician have to sign the physician order for diagnostic tests?
A6. No. Although no signature is required on an order form for a clinical diagnostic test paid on the Laboratory Fee Schedule, the physician must clearly document, in the medical record, his or her intent to have the test be performed. The entity providing the laboratory test results must maintain all documentation, including the physician order and the test findings, to support the claim submitted. Laboratory medical records are requested to determine correct billing and medical necessity. Tests not ordered by the physician who is treating the beneficiary are not reimbursed.

The following are examples of acceptable documentation: An order, signed by the physician; A signed requisition Note: A requisition (or order) not signed by the physician does not support physician's intent for the test to be performed; A notation in the patient's medical record documenting the need for or the intent to obtain a specific test, signed by the physician; A verbal or telephone order - documented at both the treating physician's office and the testing facility - and placed in the beneficiary's medical record (must be signed within the time frame specified by the state.); An email from the physician that may be verified; Another type of electronic requisition transmitted from the treating physician to the testing facility that requires a password, with proof of the process in writing (e.g., attestation).