tci Part B Insider - 2004 Issue 39

Respond To CERT Requests Or Face Claims Denials

Last year's 8 percent non-response rate to Comprehensive Error Rate Testing (CERT) record requests dropped to only 1 percent in 2004, thanks to strong-arm tactics from the Centers for Medicare & Medicaid Services. Now if you don't reply, you risk being sent to the HHS Office of Inspector General - and your claim risks denial.CERT contractor AdvanceMed chooses about 28,000 claims per year for review to see whether providers are billing (and Medicare contractors are paying) correctly, explained Wayne Steiner, CERT coordinator for Part B carrier HGSAdministrators. ...

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