The Part A/B Medicare administrator contractors (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.
Medical record requests
Medical records may be requested by the CERT or other Medicare contractors. You may use the following links to access medical documentation checklists to assist you in responding to requests for medical records.
CERT program reference guide -- this guide shows the complete CERT process, including how to respond to medical record requests.
CERT claims identifier (CID) lookup
The CERT CID lookup was developed so providers can obtain a status of their CERT sampled claims. This tool provides information for sampled claims where a decision has been made by the CERT review contractor or is pending review.
View CERT articles and resources on the First Coast Service Options (First Coast) website
View articles and resources pertaining to medical documentation on the First Coast website
Courses and interactive tools
The proper use of the KX modifier -- this simulation is designed to help you understand when to use the KX modifier.
Physician signature requirements for medical documentation -- this simulation provides direction on requirements of the physician’s signature for all medical documentation.
Medical Documentation Request – This course addresses key components of the documentation request, including, timeframes in which to respond to requests, recommended items to include , and acceptable submission methods.
Progressive Corrective Action (PCA) (Part A/Part B) -- Learn about the mission and goal of the medical review process and how data analysis drives the identification of aberrances.
Tips and frequently asked questions (FAQs)
Comprehensive Error Rate Testing (CERT) tips -- the CERT contractor continues to report the number one reason overpayment letters are sent to providers is because of reasons found in this article. We encourage our providers to save time and money by reviewing the tips provided.
FAQs regarding the CERT program -- review questions and answers pertaining to the CERT program.
List of CERT reports -- includes the annual Improper Medicare Fee-for-Service Payment report.
'CERT Signature Requirements' fact sheet -- covers common denials related to signature requirements and medical documentation.
CERT Process for Handling a Provider’s Allegation of Medical Record Destruction (SE0547) -- outlines the process Medicare providers should follow when requested medical records are destroyed by disaster.
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.
Medicare Learning Network® (MLN) Products Provider Compliance page -- find educational products on how to avoid common billing errors and other improper activities.
Overview of CERT program -- this section of CMS’ website offers an overview of the CERT program.
Comprehensive error rate testing contact information -- this document includes information on how to contact the CERT documentation contractor.
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.