COMPLIANCE: CERT Slip Will Bring You OIG Attention

Why This Topic Matters

Understanding CERT follow-up procedures helps providers and compliance teams recognize the operational and oversight risks associated with delayed responses to medical record requests. The article also places those procedures in the broader context of CMS error rate reporting and OIG involvement.

Article Sections

1. Non-response to CERT record requests

   Introduces the issue of delayed responses to contractor medical record requests and the concern that follows when providers do not reply promptly.

2. CMS oversight and error rate reporting context

   Describes CMS involvement in Medicare payment error rate reporting and the broader reporting context surrounding CERT activity.

3. Carrier and intermediary follow-up actions

   Summarizes the timing and types of follow-up contacts CMS expects contractors to make when records are not received.

4. Referral to regional OIG staff

   Explains the escalation path discussed in the article when the requested records are still not received after contractor and carrier follow-up.

5. Criticism of the process

   Covers the concerns raised about how the request process is communicated and the impact on providers who do not respond in time.