Comprehensive Error Rate Testing (CERT)
The Centers for Medicare & Medicaid Services (CMS) has developed
the Comprehensive Error Rate Testing (CERT) program to produce national,
contractor specific, and service-specific paid claim error rates.
The program has independent reviewers periodically reviewing random
samples of Medicare claims that are identified as soon as they are
accepted into the claims processing system at the Medicare contractors.
The independent reviewers medically review claims that are paid and
claims that are denied to ensure that the decision was appropriate.
The statutory authority for requesting medical records and claims
information fall under Section 1833 (e), Title XVIII of the Social
Security Act, which provides that you must supply such information
as is necessary to determine whether Medicare payments are or were
due under this title. Failure to comply with request for medical
records will result in a denial and recovery of payments for all
services provided on the dates in question.
If the requested information is not received within the specified
time frame, CERT will assume that the services on the claim were
not rendered and will direct us to pursue overpayment recoupment
for these undocumented services.
About CERT/HIPAA
- CERT Process Overview
- HIPAA
- CERT Documentation Contractor Process Flow Diagram
CERT Sample Letters
- Initial Request For Medical Records
- Second Request For Medical Records
- Third Request For Medical Records
- Final Request For Medical Records
- Tech Stop Request For Medical Records
CERT NewsLetters
CERT Articles
- Bar Coded Cover Sheets
- Billing 99211 for Anticoagulation Management
- Call Center Problem Tickets
- CERT Documention Center (CDC) Toll Free Number
- CERT Documentation Contractor (CDC) Analysis of Tech
Stops
- CERT Documentation Contractor Transition Medical Record
Request and Receipt Functions
- CERT Documentation Contractor (CDC) Updated Call Center
Operations Process
- CERT Documentation Pointers
- CERT Documentation Tips for Outpatient Therapy
- CERT Fact Sheet
- CERT Improper Fee-for-Service (FFS) Error Rates : November 2007 Improper Medicare Fee for Service Payment Report Results
- CERT May 2007 Report - One Top Reason for Errors: Services Incorrectly Coded
- CERT Provider Address Web site Now Available
- CERT Request for Documentation
- CERT Reminder
- CERT Tech Stops
- CERT Tips for Documentation
- CERT To Begin New Process June/July 2005
- CERT vs HIPAA (Health Insurance Portability
and Accountability) Compliance
- Decreasing the CERT Error Rate
- Explanation of Differences in Contractors
- Faxing Documentation to the CERT Documentation Contractor
(CDC)
- Five Step Process for E&M Billing
- Helpful Hints for Faxing Documentation
- Medicare Continues To Reduce Improper Claims Payments
- Medical Necessity for E&M Services
- New Schedule of CERT Documentation Contractor Calls and Medical Request Letters
- Potential Fraud Referrals
- Progressive Corrective Action on Chiropractic Manipulative
Treatments
- The Importance of Complying with Requests for Claim Documentation
- The Importance of Documentation
- Third Party Documentation
- Tips for Preventing E&M Coding Errors
- Update on Probe Reviews of Chiropractic Manipulative Treatments
The Review Process
- Incorrect or No Documentation
- CERT Review of Records
CERT Appeals
- The Appeal Process
- Where to Send the Appeal
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CERT Frequently Asked Questions
CERT Tips on How to Avoid Errors
- Services Incorrectly Coded
- Lack of Documentation
- Insufficient Documentation
- Lack of Medical Necessity
- Services not Performed
Error Rates and Provider
Benefits
- Error Rate Reports
- Provider Benefits
Submitting
Documentation
- What Documentation to Submit
- How to Submit Records to CERT
CERT
Web Training
- CERT
- Understanding Evaluation and Management Guidelines (Parts
1-3)
CERT Contact Information
- Julene Mull
CERT Coordinator, Part B
CIGNA Government Services
615.782.4591 (voice)
615.782.4480 (fax)
Julene.mull@cigna.com
- CERT Documentation Office
9090 Junction Drive, Suite 9
Annapolis Junction, MD 20701
301.957.2380 (voice)
240.568.6222 (fax)
Links to Web sites
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Part B Site Links