News: CMS transitions CERT contractors

The Comprehensive Error Rate Testing (CERT) program received a new assignment this summer. On August 16, CMS awarded CERT Review Contractors work to AdvanceMed, an NCI company, eliminating the existing CERT Documentation Contractors effective October 13, 2016, according to a statement published by CMS.

The CERT program is a post-payment auditing function and focuses on billing errors that result from no or insufficient provider documentation, medical necessity, incorrect coding, and other issues, such as duplicate claims or non-covered services. The CERT contractor performs this function by randomly selecting a statistically valid sample of processed Medicare claims and requesting the associated medical documentation from the provider. Once the records are received, the CERT professional audits the chart to determine whether the claim was paid appropriately.

Using the audit information from the CERT contractor, CMS then calculates a national improper payment rate and uses it to measure the performance of Medicare Administrative Contractors (MACs) to gain insight into the causes of errors. CMS publishes the results of these reviews annually, which CDI leadership may use to pinpoint areas of risk related to documentation and coding.

The work currently performed by CERT Documentation Contractors will be transitioned to the Review Contractors and fully operational on October 14, 2016. October 6 is the last day that the current CERT Documentation Contractor will be receiving medical records and CERT inquiries at their location.

Beginning on October 7, the CERT Provider Website and the CERT Documentation Portal (which will eventually become the CERT Claim Status website) will undergo updates to add new features and additional functionality. Providers will not be able to update their contact information for the CERT program until after October 13.