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| December 2009 CERT Alert: National Government Services Role in the Comprehensive Error Rate Testing Program National Government Services role in the CERT process is one of a liaison for the CERT contractor. As the liaison, National Government Services receives instructions (feedback) from the CERT contractor for any claims with a CERT error. Per instructions from the Centers for Medicare and Medicaid Services (CMS) and the CERT contractors National Government Services adjusts the claim based on the CERT decision, whether the records did not support medical necessity, the service was incorrectly coded, if records are not received or incomplete, or the claim was processed incorrectly. National Government Services is also responsible to help providers/suppliers:understand what type of documentation is being requesting by the CERT Documentation Contractor (CDC)explain why the CERT Review Contractor (CRC) denied or recoded the claimprovide education on the trends that our data analysis shows The CERT program goal is to measure and improve the quality and accuracy of Medicare claims submission, processing and supporting medical documentation requirements. The functions of the CERT program are shared by two contractors: The CERT Documentation Contractor (CDC) that requests the records.The CERT Review Contractor (CRC) which makes the medical review decisions as to whether the claim is billed correctly and/or medically necessary. The CERT contractors randomly select claims for review, request the medical records and make coverage determinations. National Government Services is not responsible for any aspect of the review of any claims selected as part of the CERT claim sample or the medical decision making on those claims. What the provider can control:where and to whom the CERT request letters are being sent by updating the CERT website at http://www.certcdc.com/certproviderportal/pages/, select Provider Directory and key your Medicare number (use group Medicare number for a group practice)finding out the status of any claim selected by CERT by contacting National Government Services at Clinical.Education@Wellpoint.com, indicate your Medicare number, state, CID#, and contract typebeing informed of CERT issues by reviewing the National Government Services website at www.NGSMedicare.com, select Review Process then Comprehensive Error Rate Testing from the Quick LinksAnd IF you receive a refund request on the basis of a CERT determination, and IF there is additional information to support coverage of the claim, you may decide to appeal the CERT decision. |
| Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site. CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message. To unsubscribe/change profile: click here. |
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