CERT Errors for Oxygen Top 70 Percent in Jurisdiction D

FARGO, N.D. — A Dec. 23 notice from Noridian
Administrative Services, the Jurisdiction D DME MAC, said the
Comprehensive Error Rate Testing (CERT) contractor has been
identifying “a significant number of errors on claims for oxygen
with the most recent error rate at 71.17 percent.”

According to NAS, oxygen is the highest source of errors in the
jurisdiction, with most due to insufficient documentation to
support medical necessity.

NAS said that based on reports it has received, documentation
the CERT contractor is looking for includes:

• Copy of the qualifying blood gas study to support the results
  noted on the Certificate of Medical Necessity (CMN);
• Clinical records documenting the patient has severe lung
  disease or hypoxia related symptoms that are expected to improve
  with oxygen;
• Clinical records showing medical management/oversight;
• Clinical records showing continued need; and
• Patient evaluation
  • Within 30 days of initial CMN and/or
  • Within 90 days of recertification.

See the notice on the NAS website.