Are healthcare providers required to comply with the CERT contractor’s request for medical records?
Yes. The CERT process is a federally mandated program. Non-submission of medical records may result in a denial or reduction in payment for the provider. • How is compliance with the CERT contractor’s request for medical records beneficial to providers? Compliance with the CERT process benefits the provider by ensuring the appropriate reimbursement of the provider’s claims, preventing unnecessary denials and appeals, may prevent additional medical review of providers and/or provider industry, and reflects a positive impression of the provider industry by having a low error rate. • How does the CERT contractor’s request for medical records impact HIPAA compliance issues? Providing medical records of Medicare patients to the CERT contractor is within the scope of compliance with HIPAA. • How will providers recognize a CERT contractor request for medical records? CERT requests will either be mailed or faxed. If mailed, the request will arrive in a tan envelope printed with the words Immed
