December 22, 2006
Comprehensive Error Rate Testing (CERT)
Remember the importance to complying with requests from the CERT Documentation Contractor office for medical records needed for the CERT program.
The CERT program produces national, contractor-specific and service-specific paid claim error rates, as well as a provider compliance error rate. The paid claim error rate is a measure of the extent to which the Medicare program is paying claims correctly. The provider compliance error rate is a measure of the extent to which providers are submitting claims correctly. A portion of this error rate was due to providers not sending requested supporting documentation to the designated CERT contractor.
Reminder
- Medicare physicians, providers and suppliers must provide documentation and medical records that support their claims for covered Medicare services to the designated CERT contractor upon request. Providers who fail to submit medical documentation will receive requests for refunds from CIGNA Government Services for those services where no documentation or insufficient documentation is received.
- The provider agreement to participate in the Medicare program requires providers to submit all information necessary to support the services billed on claims. If services were rendered at another facility, the billing provider is responsible for obtaining those records for review.
- Medicare contractors do not need to obtain a patient's authorization to release medical information to the CERT Documentation Contractor. Medicare patients have already given authorization to release necessary medical information in order to process claims.
The CERT Documentation Contractor sends a written request for medical records to an individual provider that includes a checklist of the types of documentation required. Medical records should be submitted to the CERT Documentation Contractor within 75 days from the receipt date of the initial letter or the claim will be denied.
Providers should submit this documentation to the CERT Documentation Contractor via fax or mail at the number/address specified below:
FAX: 240-568-6222
CERT Documentation Office
Attn: CID #: (Claim Identifier listed at the top of the checklist)
9090 Junction Drive, Suite 9
Annapolis Junction, MD 20701
Providers may call the CERT Documentation Contractor at 301-957-2380 with questions regarding specific documentation to submit.
