Home Health & Hospice Week

Tip: Encrypt your emailed documentation per HIPAA, CERT contractor says.

It may not be as fun as other items on your holiday time to-do list, but now is a good time of year to check your claims data and revisit your protocols for how to handle overpayments, additional documentation requests, and appeals.

Reminder: While Medicare’s new payment error rate data shows the home health and hospice error rated declined significantly this year, most of the errors that were discovered were overpayments. In fact, overall CMS identified $31.6 billion that went out to Medicare providers in error.

CERT errors aren’t just an academic exercise. MACs move to recoup the identified overpayments.

Do You Know How To Respond To A CERT Audit?

The new CERT report highlights the importance of acting on medical review requests promptly, experts emphasize.

You can respond to a CERT request in several ways, according to Michael Hanna at CGS DME Medicare Administrative Contractor Jurisdiction C in Nashville, Tennessee, in a recent webinar.

Take a look at Hanna’s advice and other expert tips on CERT correspondence:

Fax: This is the preferred method, Hanna says. “Always include the barcode sheet as part of your fax package. This simply marries the documentation you’re submitting with that particular date of service the CERT contractor has chosen for a review.”

esMD: The electronic submission of medical documentation system (esMD) is another option. With this method, you use the gateway you contracted with and follow standard procedure.

Postal Mail: “If it’s a sizeable amount of documentation, or you’ve already saved it to a CD, you can mail it in,” Hanna adds. If you send a CD, it can only contain TIFFs or PDFs and should be encrypted in line with HIPAA Security Rule standards, according to CERT Review contractor AdvanceMed.

Email: You may send an encrypted email, but “if [it’s] encrypted, the password and CID# must be provided” with a follow-up phone call or fax, advises AdvanceMed.

Don’t miss: You can make extension requests by telephone only. And the CERT contractor grants extensions only in extreme circumstances such as natural disasters like hurricanes, tornadoes, and ongoing fires, according to Hanna.

“If you are simply waiting on medical records from the physician, it is possible the CERT contractor may not grant that extension,” Hanna acknowledges. “If that is the case, you should always send the CERT contractor what you have available, and then if they disagree or find something missing or not valid, you do have appeal rights.”

Any claim errors the CERT contractor finds will result in a revised Medicare admittance advice denying that claim and an overpayment demand asking you to repay the money, Hanna cautions.