Announcements and Reports

The Centers for Medicare and Medicaid Services (CMS) expects that most Health Insurance Prospective Payment System Code (HIPPS) corrections will be made during the beneficiary’s Medicare Part A stay. Therefore, providers that routinely submit corrections after the beneficiary’s Part A stay has ended may be subject to focused medical review.

The Part A, Part B, Durable Medical Equipment (DME), Home Health and Hospice, and Railroad Board (RRB) Medicare Administrative Contractors (MACs) are working together to promote the importance of complying with CERT documentation requests. This is the third of four articles in our CERT Awareness Month.

The Part A, Part B, Durable Medical Equipment (DME), Home Health and Hospice and Railroad Board Medicare Administrative Contractors (MACs) are working together to promote the importance of complying with Comprehensive Error Rate Testing (CERT) documentation requests. This is the second of four articles in our CERT Awareness Month.

The CERT review contractor issues an Additional Documentation Request (ADR) to obtain medical records for each claim line sampled for CERT review. The CERT review contractor initial letter request schedule has changed. Beginning with Review Year (RY) 2026 providers will only have 60 days to respond to these requests and if no records have been submitted, your claim will deny for non-response. Responding within 45 days, if not before, is always best practice to ensure timeliness. 

The Comprehensive Error Rate Testing (CERT) process created a way for CMS to look at the accuracy of claims processed by all Medicare Administrative Contractors (MACs). The CERT contractor reviews a random sample of processed claims to determine if there has been an improper payment. An improper payment may have been made if a claim should have been fully or partially denied or paid at a different level based on the submitted documentation. 

CMS will permanently reduce the Comprehensive Error Rate Testing (CERT) program sample size starting with reporting year (RY) 2025. The sample size for improper payment measurement review will decrease from 50,000 to 37,500 claims annually.

Did you know you can log onto the CERT C3HUB (cms.gov) to obtain claim review status information under the Claim Status Search feature. This website is operated by the CERT Contractor and updated daily. Your CERT information is still available within our eServices portal, however this information is updated on a monthly basis.

This article provides the current Comprehensive Error Rate Testing (CERT) contractor's contact information.

When a provider receives a Comprehensive Error Rate Testing (CERT) error for incorrect coding, it means the documentation submitted for review by the provider does not match the codes billed for the claim.