CERT (Comprehensive Error Rate Testing) vs HIPAA (Health Insurance Portability and Accountability) Compliance
During a CERT review, you may be asked to provide more information related to a claim you submitted, such as medical records or certificates of medical necessity, so that the CERT review contractor can verify that billing was proper. Be assured that forwarding specifically requested records to the designated CERT contractor does NOT violate privacy provisions under the HIPAA law. The Centers for Medicare & Medicaid Services (CMS) has contracted with the CERT Documentation Contractor and the CERT Review Contractor to conduct the activities of the CERT program. As a Medicare contractor and in accordance with Section 1816 and 1842 of the Social Security Act, the CERT contractors are authorized to request claims and medical records from providers and suppliers of Medicare services. Physicians, providers and suppliers do not need to obtain additional beneficiary authorization to forward medical records to the designated CERT contractor.
Should you receive a letter from CMS regarding a CERT request for medical documentation, you should respond promptly by submitting the requested supporting documentation within the time frame outlined in the request.
If you have any questions, call CERT Customer Service at (301) 957.2380 between the hours of 8:00 AM to 6:00 PM EST.