Fast facts: CERT support - who we are and what we do
Who we are:
The Comprehensive Error Rate Testing (CERT) Support team is comprised of supervisors, CERT analysts, CERT support associates (CSA) and targeted education specialists (TES). The CERT Support team is a department within the MAC.
The CERT review contractor (RC), CERT documentation contractor (DC) and the CERT statistical contractor are all separate contractors from the MACs.
What we do:
As the CERT Support team, our primary responsibilities are twofold: the first is to comply with all MAC requirements for the CERT program set forth by CMS in the Program Integrity Manual (PIM) section of the Internet Only Manual (IOM), and the second is to lower the specific CERT error rate for First Coast.
For activities related to the CERT program (after the second subsequent ADR letter), we contact providers to obtain requested medical record documentation that supports the services they have billed on claims sampled, educate them on what information or documentation is missing, and then assist them in delivering the documentation to the CERT contractor.
We are responsible for maintaining the MAC-supplied data on the C3HUB, which is the CERT Contractor's website portal for gathering MAC responses and updates to claims in the CERT sample that have been identified as having errors.
We then provide specific education to providers who receive CERT errors by reviewing Medicare rules and regulations and encouraging providers to appeal or submit documentation to overturn the errors.
The CERT data reported on the C3HUB is supplied to CMS and formulated into both a national and MAC-specific report each year. CERT Support's management and analysts are responsible for receiving and reviewing this report, as well as contributing CERT data for CMS reporting.
In addition, for non-CERT related activities, and upon request from other departments, we educate providers who do not rise to the high priority of a medical record or clinical review but need to be notified of aberrant billing practices.
CERT Support partners with all departments in Program Integrity, as well as Provider Outreach and Education (POE) to protect the Medicare Trust Fund for Medicare beneficiaries.