Comprehensive Error Rate Testing
CERT Documentation for Inpatient Services
Outstanding documentation requests for Medicare Part B services furnished in an inpatient setting (ex., hospital, nursing home) continue to be an area of concern that directly impacts our CERT error rate. In our attempts to obtain documentation from billing providers, we are often informed that the records are not available and we are instructed to request the necessary documentation from the facility.
Please be aware that all services billed to Medicare Part B must be documented as billed. As a Medicare provider, you must provide documentation and medical records to the CERT Contractor upon request to support claims for Medicare services. It is your responsibility to obtain any additional documentation from a third party (hospital, nursing home, etc.) as necessary.
Failure to submit the requested records to the CERT Contractor may result in the identification of a total overpayment for the service(s) billed to Medicare Part B.
If you have questions regarding what documentation is needed to fully comply with the CERT record request, you may contact the CERT Contractor at (804) 264-1778.
For more information on CERT, please visit our CERT Web page or the CMS Website at http://www.cms.hhs.gov/cert/.
