Claim Specific CERT Errors- January <strong>2012</strong>J10 MAC B (Alabama, Georgia, Tennessee)Carrier 00512 (Mississippi)The Comprehensive Error Rate Testing (CERT) Program was implemented by the Centers for <strong>Medicare</strong> &Medicaid Services (CMS) to monitor the accuracy of claims processing by <strong>Medicare</strong> contractors, like<strong>Cahaba</strong>. Contractors are then notified by CERT of the errors and findings.We would like to remind you that should you receive an Additional Documentation Request (ADR) such asa request for records to support services that are involved in a CERT review, you should submit theappropriate documentation to support the services billed, including but not limited to progress note(s) tomatch the DOS billed, lab results, operative reports, diagnostic tests, physician orders, etc. <strong>Medicare</strong>requires a legible identifier for services provided/ordered. The method used shall be hand written or anelectronic signature (stamp signatures are not acceptable) to sign an order or other medical recorddocumentation for medical review purposes.Providers may appeal unfavorable decisions with additional supporting documentation. For detailedinformation regarding the Appeals Process, refer to the following link:www.cahabagba.com/part_b/claims/appeals_process.htm.Please contact the Provider Contact Center for individual questions concerning CERT errors:Alabama, Georgia and Tennessee Providers – 1-877-567-7271Mississippi Providers – 1-866-419-9454This summary provides examples of <strong>Cahaba</strong>'s errors identified by CERT. We encourage all providers toreview this listing to educate you on common errors. This information will be updated periodically. Theintent in providing this information is to prompt you to conduct an internal analysis of <strong>Medicare</strong> billing andreduce future denials by <strong>Medicare</strong>.<strong>Medicare</strong> B <strong>Newsline</strong> <strong>March</strong> <strong>2012</strong> 28
News Flash Messages from CMS For All <strong>Part</strong> B ProvidersPresident Obama Signs the Middle Class Tax Relief and Job CreationAct of <strong>2012</strong>--New Law Includes Physician Update Fix through December <strong>2012</strong>--On Wednesday, February 22, <strong>2012</strong>, President Obama signed into law the Middle Class Tax Reliefand Job Creation Act of <strong>2012</strong> (Job Creation Act). This new law prevents a scheduled payment cutfor physicians and other practitioners who treat <strong>Medicare</strong> patients from taking effect on <strong>March</strong> 1,<strong>2012</strong>. The new law extends the current zero percent update for such services through December 31 ,<strong>2012</strong>. President Obama remains committed to a permanent solution to eliminating the SustainableGrowth Rate reductions, which result from the existing statutory methodology. The Administrationwill continue to work with Congress to achieve this goal, as well as implement the policies in theAffordable Care Act to move toward a patient-centered, quality oriented system.The new law extends several provisions of the Temporary Payroll Tax Cut Continuation Act of 2011(Continuation Act). Specifically, the following <strong>Medicare</strong> fee-for-service policies have been extended.We also have included <strong>Medicare</strong> billing and claims processing information associated with the newlegislation. Please note that these provisions do not reflect all of the <strong>Medicare</strong> provisions in th e newlaw, as some provisions are effective later in the year and more information about those provisionswill be forthcoming.Section 3003 - Physician Payment Update - The new law extends the current zero percent update forclaims with dates of service on or after <strong>March</strong> 1, <strong>2012</strong>, through December 31, <strong>2012</strong>. However, thenew law does not extend Sections 307 and 309 of the Continuation Act, the five percent physician feeschedule mental health add-on payment and the special 2011 payment rates for bone massmeasurement, respectively. The Centers for <strong>Medicare</strong> & Medicaid Services (CMS) is currentlyrevising the <strong>2012</strong> <strong>Medicare</strong> Physician Fee Schedule (MPFS) to reflect the expiration of both of theseprovisions. In order to allow sufficient time to develop, test, and implement the revised MPFS,<strong>Medicare</strong> claims administration contractors may hold mental health and bone density claims with<strong>March</strong> <strong>2012</strong> dates of service for up to 10 business days. We expect these claims to be released intoprocessing no later than <strong>March</strong> 15, <strong>2012</strong>. Other <strong>March</strong> <strong>2012</strong> claims will be unaffected by this claimhold. Claims with dates of service prior to <strong>March</strong> 1, <strong>2012</strong>, also are unaffected. Finally, <strong>Medicare</strong>contractors will be posting the new mental health and bone density rates on their websites no laterthan <strong>March</strong> 15, <strong>2012</strong>.Section 3004 - Extension of <strong>Medicare</strong> Physician Work Geographic Adjustment Floor - Theexisting 1.0 floor on the physician work geographic practice cost index is extended through December31, <strong>2012</strong>. As with the physician payment update, this extension will be reflected in the revised <strong>2012</strong>MPFS.Section 3001 - Extension of <strong>Medicare</strong> Modernization Act Section 508 Reclassifications -Section 3001 extends Section 508 reclassifications and certain special exception wage indexes fromDecember 1, 2011, through <strong>March</strong> 31, <strong>2012</strong>. For the period beginning on December 1, 2011, and ending on<strong>March</strong> 31, <strong>2012</strong>, section 3001 also requires (as did section 302 of the Continuation Act) removing Section508 and special exception wage data from the calculation of the reclassified wage index if doing so raisesthe reclassified wage index. All hospitals receiving section 508 reclassifications and inpatient specialexception reclassifications under the Continuation Act and the Job Creation Act shall be assigned a specialwage index effective for October 2011 through <strong>March</strong> <strong>2012</strong>. We will apply these provisions to both<strong>Medicare</strong> B <strong>Newsline</strong> <strong>March</strong> <strong>2012</strong> 29
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