February 4, 2008
Comprehensive Error Rate Testing (CERT) Tips
CERT Documentation Helpful Tips
As you may be aware, the CERT Documentation Contractor is responsible for requesting and receiving medical record documentation in support of the provider’s claim. Sample provider letters sent by the CERT Documentation Contractor can be found on their Web site at http://www.certcdc.com/certproviderportal/RequestLetters.aspx 
. We urge you not to disregard documentation requests sent by the CERT Documentation Contractor, as failure to provide the necessary documentation will result in the denial of the provider’s claim and overpayment recovery will be initiated. Please note that patient authorization is not required to be obtained by the provider in order to respond to the documentation request and that providing medical records of Medicare patients to the CERT Documentation Contractor is within the scope of compliance with the Health Insurance Portability and Accountability Act (HIPAA).
. We urge you not to disregard documentation requests sent by the CERT Documentation Contractor, as failure to provide the necessary documentation will result in the denial of the provider’s claim and overpayment recovery will be initiated. Please note that patient authorization is not required to be obtained by the provider in order to respond to the documentation request and that providing medical records of Medicare patients to the CERT Documentation Contractor is within the scope of compliance with the Health Insurance Portability and Accountability Act (HIPAA).Here are a few suggestions when preparing the medical record prior to faxing or mailing (tips from CERT Newsletter, September & December 2007 editions http://www.certcdc.com/certproviderportal/newsletters.aspx ):
):• If at all possible, do not staple, paperclip, or mail documents in binders. Even though each page is reviewed before it is scanned in, the process can be dramatically improved if there is less time spent on preparation. It is not necessary to separate the pages unless they belong to more than one patient.
• Place the bar coded cover sheet on top of the medical records/documentation when mailing records in. That coversheet, which has the CID number on it, can be recreated, but if it cannot be located, then the process may be affected. When submitting multiple records, place the corresponding bar coded cover sheet in front of each patient’s medical record. In order to help eliminate this confusion, we will be changing our language in the instructions for submitting requested medical records/documentation letter.
• Avoid sending copies of copies. The nurse reviewers do a great job in deciphering the images, but to make their jobs easier, please try to only send copies of the originals. That will reduce the time it takes to lighten or darken a page for legibility.
• When sending copies of records, please try to not send double-sided pages. This will increase the time it takes to image the entire record.
Does the CERT Documentation Contractor Have Your Provider’s Correct Information?
• Verify your provider’s contact information though the CERT Documentation Contractor Web site at http://www.certcdc.com/certproviderportal/verifyAddress.aspx in order to ensure that the following is correct:
in order to ensure that the following is correct:• Name or Number of Affiliated Contractor (AC)
• Provider Identification Number (all provider ID numbers affiliated with provider’s facility/office)
• Provider Name
• Business Name
• Address (where medical records are stored or the central address for all record requests to be sent)
• Point of Contact/POC (the person who has been designated as the main contact for CERT requests)
• Direct Phone Number for the POC
• Fax Number (direct number where requests for medical records can be faxed)
• E-mail address of the POC
• If the CERT Documentation Contractor has incorrect provider contact information:
• Send the correct information to the CERT Documentation Contractor directly through the “Contact Us” e-mail link at www.certprovider.org .
.• Call the CERT Documentation Contractor Call Center at (301) 957-2380 or toll-free at (888) 779-7477 from 8 AM to 8 PM Eastern Standard Time (EST) in order to speak with a Customer Service Representative and update the information.
• For those providers with large group practices, information can be provided electronically in a Microsoft Excel spreadsheet or Access database format.
• Many providers use the same billing number for multiple provider sites/locations. The record request goes to the address listed on the Medicare provider address file in the MCS (Multi-Carrier System) and contact is initiated using the phone number that correlates to that address. This address/phone contact information is often not updated or does not reflect the contact information where the medical records for that claim are housed. Therefore, we strongly suggest that you assign a central contact person for each provider entity for all CERT documentation requests. That point of contact (POC) can then ensure that the requests get to the correct provider site for record response.
• Providers updating their address and POC information on the CERT provider Web site www.certprovider.org that are associated with multiple Affiliated Contractors should update the information on the Web site for each AC the provider is associated with. The information will not automatically transfer if the provider is associated with more than one AC. Therefore, if the provider has one point of contact for CERT and is associated with multiple ACs, the information must be entered multiple times on the CERT provider Web site under the individual contractor number in order for the POC information to appear when a search is conducted for a particular AC. (Tip from CERT Newsletter September 2007 http://www.certcdc.com/certproviderportal/newsletters.aspx )
that are associated with multiple Affiliated Contractors should update the information on the Web site for each AC the provider is associated with. The information will not automatically transfer if the provider is associated with more than one AC. Therefore, if the provider has one point of contact for CERT and is associated with multiple ACs, the information must be entered multiple times on the CERT provider Web site under the individual contractor number in order for the POC information to appear when a search is conducted for a particular AC. (Tip from CERT Newsletter September 2007 http://www.certcdc.com/certproviderportal/newsletters.aspx )Additional Information
In addition to the references listed above, more information concerning the CERT program is available on the Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.hhs.gov/cert/
