What do providers risk in not responding to the CERT request made by AdvanceMed?
A. Providers that do not respond to the CERT request will receive an “error” and will be assessed an overpayment. Providres who repeatedly do not respond to a CERT request for documentation are considered “recalcitrant”. Recalcitrant providers with a claim line total or claim total of $40.00 or more in question may be referred to the OIG for action. Q. Why has our facility received denials for insufficient documentation when we never received an initial request for medical records from CareFirst of MD, Inc. Medicare Part A? The FISS system shows that these claims were previously paid. Can these claims be appealed? The claim denails were Comprehensive Error Rate Testing (CERT) denials reviewed by the CERT contractor who contracts with CMS to complete these reviews. The CERT contractor sends a letter requesting records for their review; however, the CareFirst logo would not appear on the letter. When complete records are not received, CareFirst is notified by the CERT contractor to recou
Related Questions
- If an AHJ does not agree with the manner in which a risk assessment is done, can the AHJ request additional testing by the AECO?
- May a participant in a health risk assessment later request an amendment to or a restriction of the assessment information?
- What do providers risk in not responding to the CERT request made by AdvanceMed?
