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CERT resources center

What is CERT?
CMS established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. First Coast uses CERT data to identify areas of focus for medical review and provider outreach and education efforts. The improper payment rate is released annually in the Department of Health and Human Services (HHS) Agency Financial Report (AFR).
In the spotlight
First Coast provides a variety of CERT-related educational resources to assist providers with navigating CERT program requirements and achieving Medicare program compliance. Review our newest releases of the CERT Insider's Guide, Fast facts, and Skilled nursing facility spotlight.
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Medical documentation and checklists
For each claim sample selected, the CERT review contractor requests medical records from the provider or supplier that submitted the claim. First Coast has compiled resources and checklists to help guide you when responding to CERT documentation requests.
more CERT checklists -- these checklists provide a reference for use when responding to CERT documentation requests for the selected claim sample.
What's the status of my CERT review?
This tool provides information for sampled claims where a decision has been made by the CERT RC. The file will indicate current status of the review upon entry of the control identification number (CID). Data is refreshed weekly.
For more information about the status of the CERT review, you can also visit the CERT C3HUB website external link and select "Claim Status Search" from the menu.
Appealing a CERT error
If the CERT RC claim review results in an error and you disagree or have additional documentation to support the billed service, you should submit an appeal to First Coast within 120 days from the date on the most recent remittance advice. For step-by-step instructions for completing an appeal request, visit the Appeals homepage.
The Part A/B MACs joined forces to communicate national issues of concern regarding improper payments to the Medicare program, resulting in the creation of the A/B contractor Comprehensive Error Rate Testing (CERT) task force.
FAQs
more FAQs regarding the CERT program -- review questions and answers pertaining to the CERT program.
CMS and CERT resources
more List of CERT reports external link -- includes the annual Improper Medicare Fee-for-Service Payment report.
more 'CERT Signature Requirements' fact sheet external PDF -- covers common denials related to signature requirements and medical documentation.
more Recommendations regarding the development of a model compliance plan for clinical laboratories the Office of the Inspector General (OIG) and other federal agencies have emphasized the importance of compliance plans.
more Medicare Learning Network® (MLN) Products Provider Compliance page external link -- find educational products on how to avoid common billing errors and other improper activities.
more Overview of CERT program external link -- this section of CMS' website offers an overview of the CERT program.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.