Comprehensive Error Rate Testing (CERT) is a program developed by the Centers for Medicare & Medicaid Services (CMS) to randomly audit claims monthly to determine if they processed correctly. Contractors then use this information to determine the cause of errors working to resolve them.

It is important to protect the Medicare trust fund and determine error rates nationally and regionally. The error rate assists CMS in determining a contractor’s future so it is important for Novitas Solutions to educate our customers about proper billing techniques.

A request for medical records from AdvanceMed alerts you that one of your claims has been selected as part of the monthly random sample. If you have a specific contact that you would like to receive requests, please make this known by visiting the CERT Provider Web site.

A letter will be sent to your office requesting the medical documentation. You need to comply in a timely manner with the request. No response or sending in only part of the requested documentation will result in a CERT denial and a refund of monies previously paid.

CERT A/B MAC Outreach and Education Task Force

A collaboration of all Part A/B MACs will be providing educational programs and information for providers on national issues of concern regarding payment errors. Information on this initiative is available here.