Pennsylvania Physicians Facing CERT Audits
Physicians in Pennsylvania are being audited under Medicare’s Comprehensive Error Rate Testing (CERT) program, which monitors and reports the accuracy of Medicare Part B fee-for-service payments.
Audits have focused on inpatient and outpatient consultations—particularly for cardiologists, neurologists, pulmonologists, and internal medicine physicians—because of higher-than-average error rates.
Some consultations should have been billed as visits, while others do not have the correct documentation to support the code level being billed.
The latest CERT analysis showed that consultations, especially CPT codes 99245 and 99255, are the number one drivers of the Medicare Part B CERT error rate. Highmark Medicare Services is reviewing these services to determine the underlying causes for the errors and will be requesting supporting medical record documentation for some of the services billed to Medicare.
Highmark Medicare and the Pennsylvania Medical Society are providing more information and resources on CERT audits.
- Call the Pennsylvania Medical Society’s Department of Practice Economics and Payer Relations at (800) 228-7823, or your Highmark Medicare provider services representative.
- Highmark will be scheduling educational sessions on CERT. Find them on Highmark Medicare’s E/M Center, which also includes training modules and documentation worksheets.
- Highmark Medicare is looking to partner with group practices, health systems, and associations to provide additional educational programs. Contact Denise Church, outreach and education manager, at denise.church@highmarkmedicareservices.com or (412) 544-1914.
- Check the Pennsylvania Medical Society’s website at www.pamedsoc.org/CERT for upcoming announcements on county medical society educational programs.
Last Updated: 7/1/2009