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CMS Provides New Guidelines for CERT Reviews

Posted on Thursday, June 21, 2018 1:14 PM

CMS has issued Change Request(CR) 10778 which provides instructions to the Medicare Administrative Contractors (MACs) on actions they may take when the Comprehensive Error Rate Testing (CERT) contractors have identified providers who have not responded to additional documentation requests (ADRs) or when there is insufficient documentation to support the decision to pay the claim.

If the CERT contractor does not receive a response to an ADR request, they inform the MAC who has the following three options:

  1. Contact those providers who have failed to submit medical records and encourage them to submit the requested records to the CERT review contractor for review;
  2. Collect the overpayment immediately; and
  3. Collect the overpayment within 10 business days of the deadline for entering final   MAC feedback.

The implementation date is July 17, 2018.

Click here to read the full change request.


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