The CERT Program calculates the paid claims error rate for Medicare claims submitted to Carriers, Durable Medical Equipment Regional Carriers, and Fiscal Intermediaries. The Centers for Medicare and Medicaid Service receives in excess of 2 billion claims per year. CERT randomly selects a statistical sample of these claims for review to determine whether the claims were paid properly. The CERT Program uses two contractors to accomplish this work: the CERT Review Contractor and theCERT Documentation Contractor.
The CERT Review Contractor is responsible for reviewing the selected claims and associated medical record documentation. The CERT Documentation Contractor is responsible for requesting and receiving the medical record documentation from providers. The CERT Documentation Contractor call center operation attempts to make an initial telephone contact with the provider to explain the program, and follow up with a faxed or mailed medical record request letter. The request letters are specifically tailored to the medical functions and services performed by the provider. The CERT Documentation Contractor call center operates between the hours of 8:00 AM to 8:00 PM Eastern Standard Time, and their phone number is (301) 957-2380.