Documentation and CERT Program

Angie Szumlinski Compliance

CMS has a video on the Importance of Proper Documentation for providers. The video is intended to help providers and physicians understand the need and importance of medical record documentation to support the services billed. Learn about what the CERT program has identified as leading documentation errors, and what providers and physicians can do to more thoroughly document the patient’s medical record.

So what is the CERT program? CERT stands for Comprehensive Error Rate Testing. CMS implemented the CERT Program to measure improper payments in the Medicare FFS Program. Under the CERT Program, a random sample of all Medicare FFS claims is reviewed to determine if they were paid properly under Medicare coverage, coding, and billing rules. Once the CERT Program identifies a claim as part of the sample, it requests via a faxed or mailed letter, the associated medical records and other pertinent documentation from the provider or supplier who submitted the claim.

The CERT Program is managed by two contractors, the CERT Statistical Contractor (CERT SC) and the CERT Review Contractor (CERT RC). The CERT SC determines how claims will be sampled and calculates the improper payment. The CERT RC requests medical records from providers and suppliers who billed Medicare. The selected claims and associated medical records are reviewed for compliance with Medicare coverage, coding, and billing rules. To read more about the process check out the PDF provided by CMS. Stay well, stay informed, and stay tuned!