June 25, 2008
Obtaining Results of Documentation Review with the CERT (Comprehensive Error Rate Testing) Program
Background
The Centers for Medicare & Medicaid Services (CMS) uses the Comprehensive Error Rate Testing (CERT) program to measure and improve the quality and accuracy of Medicare claims submission, processing and payment. Under this program, numerous randomly selected claims are reviewed each year. The results of these reviews are used to characterize and quantify local, regional and national error rate patterns. CMS uses this information to address the error rate through appropriate educational programs.
What Providers Need to Do:
- Provide requested information. Forwarding requested information does not violate privacy provisions under the health Insurance Portability and Accountability Act (HIPAA). The request is sent by the CERT Documentation Contractor (CDC), with the official CMS logo will contain the following:
- Claim Attachment Cover Sheet
- List of the medical documentation requested
- Instructions on how to mail or fax information
- Respond Promptly
- Physicians, providers and suppliers do not need to obtain additional beneficiary authorization to forward medical records to the designated CERT contractor.
- Keep your enrollment information current. Correct address information will help ensure that CERT documentation requests are received and will allow time for your response.
CERT Results
- A letter will be mailed to the rendering provider's attention if a CERT review results in an error. Should the CERT review result in a favorable decision, no error, no letter/notice will be sent (no news is good news).
- To inquire about the results of a CERT review, please contact
us at:
Julene Mull
CIGNA Government Services
Part B CERT Coordinator
Two Vantage Way
Nashville, Tennessee 37228Phone: 615.734.4191
Fax: 615.744.9480
