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Outpatient Therapy Common CERT Errors

The Centers for Medicare and Medicaid Services (CMS) has released a new booklet where they describe common outpatient rehabilitation therapy services Comprehensive Error Rate Testing (CERT) Program errors, how the CMS calculates improper payment rates, the necessary documentation to support billed Medicare claims, and managing potential overpayments. Some of the more common CERT errors include:

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Targeted Probe and Educate: What Is It?

As many of you have found out the hard way, the Centers for Medicare and Medicaid Services (CMS) implemented a new program called Targeted Probe and Educate (TPE) where the goal of the program is to help providers and suppliers reduce claim denials and appeals through one-on-one education.

CMS uses data analysis to identify

Upon data analysis, if you are not an outlier in any of the above areas, you won’t be chosen for the TPE. Only CMS and your Medicare Administrative Contractor (MAC) has and knows this data analysis and they are not sharing it with you.

CMS states the 4 most common denials reasons are:

  1. Missing or incomplete certification and/or recertification(s)
  2. The signature of the certifying physician was not included
  3. Documentation does not meet medical necessity
  4. Encounter notes did not support all elements of eligibility

So how does the TPE program? If the provider is selected for TPE, their

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