Comprehensive Error Rate Testing (CERT) - JF Part B

Since 1996, CMS implemented several initiatives to prevent improper payments. CMS' goal is to reduce payment errors by identifying and addressing billing errors concerning coverage and coding. The CERT program is one of the programs created by CMS to assist in eliminating improper payments.

The CERT Review Contractor (CERT RC) completes audits on randomly selected claims submitted to Noridian. When a claim has been selected for an audit, the CERT RC sends a supplier a Medical Record Request Letter asking that all supporting claim documentation be pulled for the audit.

CERT Program Basics

CERT Review Process - View the process for receiving and responding to CERT requests.

CERT Documentation Requests Impacted by a Disaster - This article is for providers that have claims under CERT review and are affected by a natural or man-made disaster.

Provider Mailing Addresses and Points of Contact for CERT Requests - View CERT mailing information and how to update point of contact information with CERT and Noridian.

Billing and Documentation Help for Identified Errors

• 99211 and Incident To
• Ambulance Services
• Dear Ordering/Referring Physician Letter
• Dual-Chamber Cardiac Pacemaker Insertion Billing
• International Normalized Ratio Home Monitoring
• Laboratory Orders Must be Submitted Within 12 Months of Order
• Laboratory Services: Incorrect Billing Identified
• Major Joint Replacement for Hip and Knee - Documenting Medical Necessity
• Physician Impact on Laboratory Service Providers
• Physician's Orders for Diagnostic Laboratory Tests
• Psychotherapeutic Services and Documentation Requirements
• Surgical Pathology Medical Documentation Letter
• Teaching Physician Services and Modifier GC

Resources

• CMS Provider Compliance