Comprehensive Error Rate Testing (CERT) Program New Processes
July 28, 2017CMS calculates the Medicare Fee-for-Service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Each year, CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules.
All FIRST Additional Documentation Request (ADR) letters for CERT are sent to the address on file with the Medicare Administrative Contractor (MAC) for the provider/supplier that billed/submitted the claim. All SUBSEQUENT ADR letters can be sent to a specific correspondence address. This can be provided to the CERT Customer Service Representative (CSR). Providers who have at least ten (10) PTAN/OSCAR numbers who would like to elect a single point of contact (POC) can participate in the “chain address” program recently implemented by CERT. In order to reduce provider burden, when multiple calls are due to the same phone number, the CERT RC groups the calls so that a single contact can be made with the provider (providers) associated with that phone number to discuss all outstanding requests.