The intent of the CERT program is to protect the Medicare Trust Fund by identifying errors and assessing error rates, at both the national and regional levels. Findings from the CERT program are used to identify trends that are driving the errors, such as errors by a specific provider type or service, and assist with allocation of future program integrity resources. Claims are randomly selected for CERT review.
When a claim is selected for review, the CERT review contractor will send a letter to the provider requesting medical documentation be submitted for CERT review. The letter from the CERT program will identify the individual claim selected and different methods for submitting the documentation. Select the English or Spanish version of the 'Part A Initial Letter' to view letters applicable to home health and hospice providers.
The CERT request letter Additional Documentation Request ADR identifies the claim selected, the documentation being requested, and also includes instructions to place the bar-coded coversheet as the only coversheet to the top of your documentation.
It also provides the different methods that may be used to submit the documentation. All documentation related to the services provided must be sent to the CERT Documentation Center within 45 days of the request. However, sending your documentation sooner is strongly recommended. Rather, CERT errors usually indicate a failure to submit documentation, or a lack of documentation to support the medical necessity of the home health or hospice services provided.
It is important that you respond to any CERT request timely, as no response, or submitting insufficient documentation, will result in a CERT denial and recoupment of Medicare payments. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories.
You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Applications are available at the American Dental Association website. Please click here to see all U.
You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Applications are available at the American Dental Association website. Please click here to see all U. Government Rights Provisions. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT The ADA does not directly or indirectly practice medicine or dispense dental services.
The sole responsibility for the software, including any CDT-4 and other content contained therein, is with insert name of applicable entity or the CMS; and no endorsement by the ADA is intended or implied.
This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement. The scope of this license is determined by the ADA, the copyright holder.
End users do not act for or on behalf of the CMS. IVR: Contact Us. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement.
You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Applications are available at the American Dental Association website. Please click here to see all U. Government Rights Provisions. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose.
No fee schedules, basic unit, relative values or related listings are included in CDT The ADA does not directly or indirectly practice medicine or dispense dental services.
The sole responsibility for the software, including any CDT-4 and other content contained therein, is with insert name of applicable entity or the CMS; and no endorsement by the ADA is intended or implied. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement. The scope of this license is determined by the ADA, the copyright holder.
End users do not act for or on behalf of the CMS.
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