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CERT resources center

CERT claims identifier (CID) lookup
The Comprehensive Error Rate Testing (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.
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.
more CERT program reference guide -- this guide shows the complete CERT process, including how to respond to medical record requests.
more View CERT articles and resources on the First Coast Service Options (First Coast) website
more View articles and resources pertaining to medical documentation on the First Coast website
Courses and interactive tools
more The proper use of the KX modifier -- this simulation is designed to help you understand when to use the KX modifier.
more Physician signature requirements for medical documentation flash file -- this simulation provides direction on requirements of the physician’s signature for all medical documentation.
more Medical Documentation Request external link – 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.
more Evaluation & Management (E/M) Documentation -- Part 1 external link and Part 2 external link (Part B) -- Take this course to learn about the documentation guidelines, key components of E/M services, and documenting medical necessity.
FAQs
more FAQs regarding the CERT program -- review questions and answers pertaining to the CERT program.
CMS 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 file -- covers common denials related to signature requirements and medical documentation.
more CERT Process for Handling a Provider’s Allegation of Medical Record Destruction external pdf file (SE0547) -- outlines the process Medicare providers should follow when requested medical records are destroyed by disaster.
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.
CERT references
more Overview of CERT program external link -- this section of CMS’ website offers an overview of the CERT program.
more 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.