Comprehensive Error Rate Testing (CERT)
The CERT program is designed to determine if Medicare contractors are processing and paying claims correctly. The Centers for Medicare and Medicaid Services (CMS) developed the CERT program to determine national, contractor specific, provider compliance error rates, paid claims error rates, and claims processing error rates.
Every month, the CERT contractor selects a random sample of both paid and denied claims processed by your Medicare Administrative Contractor (MAC). The CERT Contractor sends letters to the providers who submitted those claims, requesting medical records and any additional documentation that will support the service(s) that were provided.
If you receive a letter requesting claims/documentation for CERT, and do not return the information immediately, you will receive telephone contacts and letters every 10–15 days for approximately 75 days.
If you do not return the requested claims/documentation by the 75th day, the claim will be cancelled and any Medicare reimbursement will be recouped.
Medical record documentation is a key element for payment. Common denials seen by reviews of Chiropractic care are as follows:
- Missing treatment plan
- Chief Complaint is not clearly documented
- Regions being treated are not clearly documented
Documentation Guidelines plus much much more can be found in our Medicare Course