CERT (Comprehensive Error Rate Testing) "Tech Stops"
The Comprehensive Error Rate Testing program (CERT) is a federally mandated program to monitor and improve the accuracy of Medicare payments to physicians and other providers.
The process begins when the CERT Review Contractor requests records for review for each sampled claim. After initial review of these records, the CERT Review Contractor may find that required documentation is missing. As a service to the provider and in an effort to demonstrate that the requirements for a submitted claim were met, the CERT Review Contractor will request additional documentation. This request sent for the additional documentation is known as a CERT Tech Stop.
The Tech Stop request for medical records will contain:
- Instructions for submitting Requested Medical Records/Documentation
- A Medical Records/Documentation Pull List (This document lists all codes billed on the sampled claim.)
- A Bar Coded cover sheet (This will list what additional documentation is needed for completion of the review process and should be used as the cover page when returning the documentation.)
Providers are asked to respond to this request within 15 days of the request letter. If the requested additional documentation is not received, the claim line(s) will remain in error which will result in an overpayment request to the provider. When the needed documentation is received timely and it supports the medical need for the items/services billed, the error is removed.
Documentation can be faxed to:
(240) 568-6222
You should receive a confirmation from the CERT Contractor that your fax has been reviewed. If you are unable to fax documents, please send information to the address noted below.
CERT Documentation Office
Attn: CID # xxxxxx
9090 Junction Drive, Suite 9
Annapolis Junction, MD 20701