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| CERT Errors - Oxygen The Comprehensive Error Rate Testing (CERT) contractor has been identifying a significant number of errors on claims for oxygen equipment. Most of the errors are due to insufficient documentation to support the medical necessity for the billed items. Based on reports received by the DME MACs, the documentation that the CERT contractor is looking for includes: Most recent CMN prior to the date of service (DOS) on the claimReport of the qualifying oximetry or arterial blood gas test listed on the CMNPhysician visit note within 30 days prior to the initial certification date documenting the diagnosis for which the oxygen is prescribedPhysician visit note with 90 days prior to the recertification date (if applicable)For claims subsequent to the recertification date, physician visit note supporting continued medical monitoring of oxygen use and needsWhen suppliers receive a request from the CERT contractor on an oxygen claim, it is important to assure that all of these documents are included in the response. If any of these documents is not provided, it will likely result in a request for overpayment on the claim. |
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