Your questions answered

WCH Service Bureau has been working hard on keeping you on the same page with all the relevant regulations and issues that may affect your practice in some ways. Here are the two most popular questions that we received from our clients in August: 

Question: Should I be worried about Medicare Comprehensive Error Rate Testing Program (CERT)? 
Answered by Elizaveta Bannova, CPC, CPCO, CPMA, CFPC, CMRS, education specialist at WCH Service Bureau: 
CERT is a program managed by the CMS. Its primary objective is to measure the rate of improper Fee-for-Service payments to healthcare providers. Since late 2020, the CMS has employed independent integrity contractors who check if claims are processed and paid in accordance with the guidelines. If an inconsistency occurs, these auditors contact Medicare Administrative Contractors or healthcare providers and instruct them on how to avoid such issues in the future.  
If you bill Medicare, you may receive a CERT request for medical records. There is nothing to worry about. CERT audits do not suspect fraud. They are needed just to ensure proper claim billing & processing patterns.  If you receive a CERT request – please provide the requested charts within a defined period, with a possibility to extend it. 

Question: How to bill services performed by PTA/OTA? 
Answered by Elizaveta Bannova, CPC, CPCO, CPMA, CFPC, CMRS, education specialist at WCH Service Bureau: 
Effective January 1, 2020, healthcare providers must indicate the outpatient services performed in whole or in part by a physical/occupational therapy assistant. This can be done by adding the following modifiers to applicable procedure codes: 
CO – for services rendered by an OTA 
CQ – for services rendered by a PTA.