Medical Review Frequently Asked Questions (FAQs)

Q1. Does a provider need to sign the his/her notes if their name is in the letterhead or addressograph on the document?
A1. Yes. If the signature is illegible, the provider may submit a signature attestation statement, signature log or circle his/her name where it appears in the letterhead or addressograph. Further information on signature requirements is in the Internet Only Manual (IOM), Pub. 100-08 Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4 - Signature Requirements.

Q2. When I move on to the next round in my Targeted Probe and Educate (TPE) review, when will the next set of additional documentation request (ADR) letters start?
A2. At the end of each "round," Noridian will provide notification in writing of findings of claim results and education on potential errors identified. The next set of ADR letters requesting additional documentation will start around six to eight weeks after the findings letter is mailed.

Q3. My question involves the letter I received. In the letter, it states that the reason for the review is "CERT errors."  I am wondering if you could clarify what that means?  I am not familiar with the terminology.
A3. Since 1996, CMS implemented several initiatives to prevent improper payments. CMS' goal is to reduce payment errors by identifying and addressing billing errors concerning coverage and coding. The Comprehensive Error Rate Testing (CERT) program is one of the programs created by CMS to assist in eliminating improper payments. What a CERT error means is that the review is based on what procedure code(s) CERT is finding errors in during their review of records. CERT will notify CMS and the contractors that there were errors being found in in claim review of a certain procedure code or code range. This information may trigger a TPE review. The selection of providers to participate in the TPE review is generally a factor of who is billing this code and how often. Further information can be found on the CERT webpage.

 

Last Updated Jan 02, 2020