BILLING NEWS

Requested CERT Documentation Located at Another Facility

The Comprehensive Error Rate Testing (CERT) Program is a federally mandated program set in place to monitor and improve accuracy of Medicare payments. This program created a way for the CMS to look at the Paid Claim Error Rate and provider compliance. The CERT Contractors randomly select claims processed by a Medicare contractor for CERT medical review. They perform the medical review of the claims selected, determine accuracy of claim payment, determine recoupment of monies, if necessary, calculate the paid claim error rate and report this information to CMS.  If the requested CERT documentation is located at another facility (ex. hospital, nursing home, referring physician's office, etc.) as the billing provider, it is your responsibility to obtain the medical records to support services billed to Medicare, regardless of where the records are housed. The CERT contractor should not be referred to a third party to obtain medical records.


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INDUSTRY NEWS TAGS: Palmetto GBA, MAC JM North Carolina, MAC JM South Carolina, MAC JM Virginia, MAC JM West Virginia


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