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Comprehensive Error Rate Testing Contractor ( CERT) Alert: Therapy Services.

National Government Services would like to thank all providers for their cooperation in providing requested medical records to the Comprehensive Error Rate Testing Documentation Center (CDC). We at National Government Services appreciate your effort and encourage your continued assistance in the program.

While the response rates to CDC requests have increase, National Government Services would like to offer some additional information to help decrease denials for insufficient documentation.

When billing therapy services to Medicare, providers must be able to support the medical necessity of the service/treatment, the time spent with the beneficiary, and that the service/treatment was provided. When records are requested for medical review providing the most accurate records are essential. The following information provides an informational check list on what type of documentation should be sent to support the service/treatment you have billed. When a ‘Medical Records Request’ is received from the Comprehensive Error Rate Testing Contractor or Medical Review, please refer to the following suggested documentation check list.

Suggested TherapyDocumentation Check List:

Initial Evaluation/Reevaluations

  • Treatment Plan/Plan of Care signed and dated by physician (maybe part of the Evaluation)
    • Medicare requires every 30 days except CORF which is required every 60 days
    • If treatment plan not signed by physician, can send M.D. order if modalities listed on the order
  • Therapy Logs/notes to include total timed code treatment minutes and total treatment time for billed DOS
  • Therapy progress reports - 1 per each 10 treatment days or 1 per certification interval, whichever is less
  • Discharge note if patient was discharged

Thank you for your cooperation and with your help as we can strive to decrease the insufficient documentation CERT errors even further.

Posted: 01/14/2008

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