Fast facts: CERT administrative relief during a disaster

In the event of a disaster, the Comprehensive Error Rate Testing (CERT) program will sometimes grant temporary administrative relief to certain affected providers and suppliers.

A disaster is defined as any natural or man-made catastrophe (e.g., hurricane, tornado, earthquake, volcanic eruption, mudslide, snowstorm, tsunami, terrorist attack, bombing, fire, flood, explosion, etc.). Such a catastrophe causes damage of sufficient severity and magnitude to partially or completely destroy medical records and associated documentation that could be requested by the CERT review contractor in the course of medical review. These catastrophes also interrupt normal mail service (including US Postal delivery, overnight parcel delivery services, etc.), and/or otherwise significantly limit the provider or supplier’s daily operations. A disaster may be widespread and impact multiple structures (e.g., a regional flood) or isolated and impact a single site only (e.g., water main failure).

For information on current and past emergencies visit the CMS Emergency Response and Recovery website.

Once a disaster has been declared, the CERT review contractor will apply administrative relief, along with flexibilities and waivers related to medical review at the direction of CMS.

Administrative relief is applied to entities when the physical location or mailing address of the provider or supplier is in the area impacted by the disaster. Administrative relief does not apply to claims that have completed CERT review before the administrative relief began. The administrative relief guidelines are as follows for a period of 90 days from the effective date of the declaration:

• The CERT review contractor will not send any additional documentation requests, attempt telephone calls to request documentation, or
• Finalize review decisions on claims to providers and suppliers affected by the disaster

The CERT review contractor does not review claims for which the provider was not able to supply the medical record due to extenuating circumstances. The provider must submit an appropriate Disaster Attestation Letter which can be found on the CERT C3HUB website.