Medicare Documentation for Diagnostic Services: WPS Medicare continues to see significant Comprehensive Error Rate Testing (CERT) error findings for insufficient documentation of diagnostic services. The majority of these findings are due to lack of a signed physician order or progress note supporting the intent for the service(s) to be rendered and documentation to support the medical necessity of the service(s).
Providers must include all documentation to support services billed in response to a Medicare medical record request. For more information on Medicare requirements for diagnostic services, read the full article on our CERT page.
Home Health Service Certification Changes: Effective April 1, 2012, WPS Medicare is implementing a new edit monitoring physician services for certification (G0180) and recertification (G0179) of Medicare-covered home health services. We will deny claims that do not meet applicable criteria.
The home health agency certification code is valid when the patient begins a new episode of home health care and when the patient has not received Medicare covered home health (HH) services for at least 60 days. The home health agency recertification code is used after a patient has received services for at least 60 days (or one certification period) when the physician is certifying the patient’s continued need for home health services. The home health agency recertification code is only valid once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapse and requires a new plan of care.
Additional information regarding physician services for certification and recertification of Medicare covered home health services, including coding information, can be found on the WPS Medicare website.
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