The CERT Public website is design to provide you, Medicare providers and suppliers, with a general information/overview about the Comprehensive Error Rate Testing (CERT) Program.
Effective August 11, 2020, the Centers for Medicare & Medicaid Services (CMS) is resuming Comprehensive Error Rate Testing (CERT) program activities that were temporarily suspended in response to the public health emergency (PHE) for the 2019-Novel Coronavirus (COVID-19) pandemic. Specifically, the CERT program will resume sending documentation request letters to and conducting phone calls with providers or suppliers to request medical documentation for claims in Reporting Year (RY) 2021 (claims submitted 7/1/2019 through 6/30/2020) and RY 2022 (claims submitted 7/1/2020 through 6/30/2021).
Due to the cyclical nature of the CERT program improper payment measurement and the statutory timeline required for improper payment reporting under the Payment Integrity Information Act of 2019 (PIIA) (i.e., reporting annually), improper payment measurements cannot pause for an extended period without missing the statutorily required due dates.
The CERT program will not resume sending documentation request letters to, or conducting phone calls with, providers or suppliers to request medical documentation for claims in RY 2020 (claims submitted 7/1/2018 through 6/30/2019). The CERT program will report the 2020 Medicare Fee-for-Service (FFS) program improper payment rate in the November 2020 Department of Health and Human Service (HHS) Agency Financial Report (AFR) based on the data that CMS currently has or that providers or suppliers voluntarily submit.
CMS has altered CERT program activities in the short term (i.e., ceasing provider contact for RY 2020 claims) and adjusted data collection in the longer term (i.e., sample size reduction for RY 2021 and RY 2022 claims) to account for the challenges incurred by providers and suppliers during the PHE, while continuing to maintain appropriate accountability measures and meet statutory obligations.
If a provider or supplier receives a RY 2021 or RY 2022 CERT documentation request, the provider or supplier should send the requested documentation to the CERT Documentation Center.
Should a provider or supplier have questions on the documentation request or prefer the request to be made in a format other than a postal mailing please have them contact CERT Documentation Center Customer Service.
The CERT documentation requests identify that the requested documents are to be submitted within 45 calendar days of the request. However, the CERT program has the discretion to grant extensions to providers and suppliers who need more time to comply with the request. Providers and suppliers should contact the CERT Documentation Center Customer Service to identify any hardships or additional time needed with responding to a CERT documentation request. CMS will continually evaluate the CERT program activities to gauge whether any future suspension might again become necessary. Based on the cutoff dates for annual improper payment reporting, providers and suppliers will have until August 2021 to submit documentation on claims in the RY 2021 report period and August 2022 to submit documentation on claims in the RY 2022 report period.
A CERT determination can be appealed. Any party to the CERT determination, such as beneficiaries, providers, and suppliers – or their respective appointed representatives – has the right to appeal the Medicare coverage and payment decision.
We believe that this guidance is a statement of agency policy not subject to the notice and comment requirements of the Administrative Procedure Act (APA). 5 U.S.C. § 553(b)(A). For the same reasons explained above, the CMS additionally finds that, even if this guidance were subject to the public participation provisions of the APA, prior notice and comment for this guidance is impracticable, and there is good cause to issue this guidance without prior public comment and without a delayed effective date. 5 U.S.C. § 553(b)(B) & (d)(3).
This website contains the following features:
About CERT - This webpage covers a brief description about the CERT program and the functions of the two CERT contractors: The Review Contractor and the Statistical Contractor.
Submit Records to CERT - This webpage provides instructions to providers and suppliers on how to submit medical documentation to the CERT Review Contractor. There are five submission methods.
Letter and Contact Information - This webpage notifies providers and suppliers of the schedule the CERT Review contractor uses to mail out the initial and subsequent Additional Documentation Request (ADR) letters. The timeline includes when providers and suppliers can expect to receive a telephone call.
This webpage also identifies the source of the address the CERT RC will use to mail the initial and subsequent letters. It informs providers that telephone calls will be grouped in order to reduce multiple calls to the same provider. And provides instructions on how providers that have 10 or more PTAN/OSCAR numbers can join the chain address program.
Attestation Letters - This webpage provides a sample of the Disaster Attestation Letter. Providers and suppliers are required to submit this letter when the medical documentation requested to support a claim has been wholly or partially destroyed in a disaster. It also includes a sample of a Signature Attestation Letter that providers and suppliers can use when the signature is illegible/missing.
Sample Request Letters - This webpage includes a sample of the initial and subsequent additional documentation request (ADR) letters that are sent to providers and suppliers. The letters are based on claim type. Both English and Spanish versions are available on this page.
Documentation Request Listings - This webpage includes a sample of the types of documents that the provider and supplier should include when they receive a CERT letter requesting medical records. This page allows the provider to select a specific documentation listing based on service within each claim/billing type.
Psychotherapy Notes - This webpage contains CMS special instructions for providing documentation for psychotherapy claims.
Contractor ID Look-up - This webpage provides a link to an Excel spreadsheet where providers and suppliers can locate the MAC contractor id used in CERT processing and communications.
Contractor ID: The Contractor Identification Number is a 5-character number that identifies the Medicare Administrative Contractor (MAC) workload responsible for processing your claims. Upon CMS instructions, the contractor ids IDs used in the CERT program vary slightly from the MAC specific workload ids IDs used for other reporting within CMS. Follow this link for a spreadsheet to assist you in identifying the appropriate Contractor IDs used for CERT.
FAQs - This webpage contains a word document with the most frequent questions asked about the CERT program.
CMS Links - This webpage has hyperlinks to various CMS topics/resources related to CERT (e.g., CERT power point, Medicare Quarterly Provider Compliance Newsletter, and information on encryption).
Contact Us - This webpage has the CERT Review Contractor’s mailing address, telephone and fax numbers and email address.