Careful what you put in M2030 (Management of injectable meds) on the OASIS - Medicare's Comprehensive Error Rate Testing (CERT) contractor reduced payment to several agencies after finding they had completed this item incorrectly.

The CERT contractor is tasked with a second level of review to evaluate the accuracy of the Medicare administrative contractors’ (MACs') work – in this case CGS. CGS shared the latest CERT findings in its June provider newsletter.

In three cases, the response on M2030 indicated the patient was receiving injectable meds, but documentation didn't support that fact. In another case, the patient had received injections, but they were administered at a physician's office and therefore shouldn't have been on the OASIS.

As a result, the agencies had their HIPPS codes for the episodes reduced and some of their episode payments recouped.

But that’s not the only error the CERT found:

  • Eight cases had errors related to therapy, such as providing services without signed physician orders or failing to support the skilled service in documentation.
  • Three cases had missing signatures and/or dates on the plan of care.
  • Two cases didn’t have sufficient documentation to support medical necessity.

The CERT also evaluated hospice claims and found certifications or recertifications were missing or insufficient in four cases.