RETIRED - Parenteral Nutrition CERT Errors - Documentation Reminder

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.

Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Joint DME MAC Publication
A recent examination of Comprehensive Error Rate Testing (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 Requirements
    • Statutory coverage requirements not met – 32%
  • Prescriptions
    • 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%
  • DME Information Form (DIF)
    • Missing DIF – 16%
  • Continued Need
    • Missing documentation – 2%
  • Continued Use
    • Missing documentation – 4%
  • Other
    • Unsigned Clinical Notes – 2%

Payment Rules          

Prescriptions:
All items billed to Medicare require a prescription. A 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 3.3.2.4.

Documentation         

In the event of a claim review:

  • Medicare requires a DWO.
  • Medicare requires that there be sufficient detailed information contained in the beneficiary's medical record to demonstrate that the relevant policy requirements were met.

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 LCD and related Policy article for complete information.

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

 

Last Updated Dec 11 , 2023