CERT Quick Look Documentation Tool

This tools displays common Comprehensive Error Rate Testing (CERT) policies under review, and the documentation that is usually required for the policy criteria to be met. This is not an all-inclusive list; it is meant to be used as a quick reference guide. For complete documentation requirements information, access/view the Local Coverage Determination (LCD), Policy Article and the Standard Documentation Requirements (SDR) Policy Article from the Active LCD webpage.

Uncheck All
 

Documentation AFO Diabetic Shoes Enteral Nutrition External Infusion Pump Drugs Glucose Monitors & Supplies Immuno-suppressive Drugs LLP Manual Wheelchairs Nebulizers & Supplies Ostomy Supplies Oxygen & Supplies PAP Devices & Supplies PMDs, Seating & Accessories Surgical Dressings TENS Urological Supplies
Dispensing Order X X X X X X X   X X X X   X   X
Detailed Written Order X X X X X X X X X X X X   X X X
Detailed Product Description                         X      
7 Element Order                         X      
Proof of Delivery X X X X X X X X X X X X X X X X
Certificate of Medical Necessity (CMN)                     X       X  
DME Information Form (DIF)     X                          
Specific Study Results                     X X        
Patient Instruction on Use of Device         X     X       X X      
Home Assessment               X         X      
MLN Matters 8304 (Affordable Care Act)       X X     X X   X X X   X  
Clinical Evaluation/ Re-evaluation and/or Clinical Records to Support Reasonable and Necessary Criteria in the Policy X X X X X X X X X X X X X X X X
Over-Utilization documentation of Medical Necessity     X   X X     X             X
Medical Documentation to Support Continued Medical Need     X X X X   X X X X X X X X X
Documentation to Support Continued Use     X X X X   X X X X X X X X X
Refill Documentation (if applicable)     X X X X     X X   X   X X X
Replacement Documentation (if applicable) X     X X   X X X X X X X X X X

 

Last Updated Oct 17, 2018