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 CPAP Devices and Supplies Diabetic Shoes Eye Prostheses Glucose Monitors and Supplies Immunosuppressive Drugs Lower Limb Orthoses Negative Pressure Wound Therapy Oxygen Equipment and Supplies Surgical Dressings Urological Supplies Ventilators
Standard Written Order X X X X X X X X X X X
Proof of Delivery X X X X X X X X X X X
Certificate of Medical Necessity (CMN)               X      
Certifying Physician Statement   X                  
DME Information Form (DIF)                      
Specific Study Results X             X      
Beneficiary Instruction on Use of Device X     X   X          
Home Assessment                      
Clinical Evaluation/Re-evaluation and/or Clinical Records to Support Reasonable and Necessary Criteria in Policy X X X X X X X X X X X
Over-Utilization Documentation of Medical Necessity       X X         X  
Medical Documentation to Support Continued Medical Need X     X X   X X X X X
Documentation to Support Continued Use X     X X   X X X X X
Refill Documentation (if applicable) X X   X X       X X  
Replacement Documentation (if applicable) including change in medical condition X   X X   X   X X X  
Supplier Documentation with Objective assessment of fit at delivery   X                  

 

Last Updated Mon, 14 Jun 2021 12:47:30 +0000