Medicare Compliance & Reimbursement - 2022 Issue 6
Compliance: Boost CERT ADR Prowess With This Insight
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Article Overview
This article covers the Medicare Comprehensive Error Rate Testing (CERT) program and its role in reviewing Medicare fee-for-service claims data. It explains how CERT documentation requests are generated, routed, reviewed, and reported, and contrasts CERT with other claims review and audit activities. The piece is useful for Medicare Part B providers, compliance staff, and revenue cycle teams that need a general understanding of the CERT process and why the program matters.
Why This Topic Matters
Understanding CERT helps Medicare providers and billing teams recognize how claims are selected for review, what happens after a documentation request is issued, and how the results are used in broader program integrity and reporting efforts.
Article Sections
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CERT Is Different Than Other Claims Review Programs
This section compares CERT with other Medicare claims review activities and describes its national sampling approach and oversight role.
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7 Steps Clarify How CERT Documentation Requests Work
This section outlines the general workflow for responding to CERT-related documentation requests, including timing, review, recoupment, and reporting.
What You Will Learn
- How the CERT program fits into Medicare claims review oversight
- How CERT documentation requests are initiated and processed
- How CERT results are used in reporting and oversight
- How CERT differs from other Medicare audit programs
Who Should Read This
- Medicare Part B providers
- Compliance professionals
- Billing and coding staff
- Revenue cycle teams
- Practice managers
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