Reprinted from DecisionHealth Daily.

An OIG report on claim payment denials shows a big, fat opportunity to reduce your own.

OIG’s report on the “pilot prject to obtain missing documentation identified in the Fiscal Year 2010 CERT program” is mainly meant to save CMS time and money by reducing their claims error rates due to missing documentation — the cost of all such transactions, including appeals and reversals, comes out of their pockets.

One feature jumped out at us.

In the OIG investigation,  an CERT review contractor sifted 136 claims denials worth more than $1,000 each and found that 46 of them could be overturned, completely or partially, when additional material was submitted that showed the medical necessity of the claims.

The report notes:

The CERT documentation contractor did not initially obtain all the necessary documentation for these 46 claims because it did not always (1) contact referring providers directly to obtain documentation to support the medical necessity of billing providers’ claims, (2) redirect followup documentation requests to compliance or reimbursement personnel, or (3) seek signature attestations when signatures on clinicians’ notes were illegible or missing.

Item 3 jumped out at us. How many of those denials, we wondered, arose because the signatures were illegible? We don’t know, but OIG does note that the CERT contractor “did not always take steps to obtain missing documentation, including signature attestations.”

This is an easy one for you. Get your doctors to clean up their sigs — and maybe update your pratice’s signature logs so that a deteriorating signature doesn’t mess up your claims. If you can get the docs to go to electronic signing, so much the better.

(One more thing, for one of our expert friends: “Maybe these CERT audits don’t indicate provider documentation deficiencies so much as they show that people aren’t responding in a timely way to CERT audit requests.  And, maybe it would be worthwhile to appeal more of those CERT-audit related denials.”)