For the past two years, Palmetto GBA has received payment error rates from the Comprehensive Error Rate Testing (CERT) Contractor that are nearly twice the national rate. A large portion of the errors are attributed to insufficient and illegible documentation, and lack of or illegible signatures. Palmetto is now taking steps to correct these errors by reviewing claims to identify potential areas for provider education.
Palmetto will notify affected physicians by mail that a small sample of their claims will be selected for medical review. The notice will also provide recommended resources on documentation and coding. Physicians who are notified will receive a request for medical records in the form of an Additional Document Request (ADR) for each claim selected, along with an example of the information that should be returned. Failure to respond to these requests will result in non-payment of the claim.
Palmetto may also make unannounced site visits to physician offices to establish a date for an educational meeting. Failure to participate in this education will result in 100 percent pre- and post-payment audit of claims. CMA is discussing the nature of these audits with Palmetto and the disruption and burden they will be to physician offices.
Please check back on the SFMS blog next week for more detailed information.