Get Ready For the CERT Task Force

When you hear the words joint “Task Force”, I am sure you assume like I do FBI/DEA or CIA/NSA hunting down terrorists or criminals.  Usually it is two or more entities that typically work alone but join together for a common goal.

The type of task force I am going to speak about is: The CERT A/B Contractor Task Force.  CERT stands for the Comprehensive Error Rate Testing program and the A/B contractor refers to the Medicare Administrative Contractors (MACs) for Parts A and B.

In case you are currently unfamiliar with the CERT program here is a brief overview:

• Measures improper payments in the Medicare Fee-for-Service (FFS) program.
• Selects a stratified random sample of approximately 40,000 claims submitted to Part A/B Medicare Administrative Contractors (MACs).
• Claims are reviewed by an independent medical review contractor to determine if they were paid properly under Medicare coverage, coding, and billing rules.
• If these criteria are not met or the provider fails to submit medical records to support the claim billed, the claim is counted as either a total or partial improper payment and the improper payment may be recouped (for overpayments) or reimbursed (for underpayments).
• Based on the findings from the claim review process, the annual Medicare FFS improper payment rate is calculated which is published in the Health and Human Services (HHS) Agency Financial Report (AFR).  

Follow this link to the CMS CERT Program website.

 See below for the listing of current MACs and their corresponding jurisdictions:

• Cahaba Government Benefit Administrators, LLC/J10
• CGS Administrators, LLC/J15
• First Coast Service Options, Inc. /J9
• National Government Services, Inc./J6 & JK
• NHIC, Corp/J14
• Noridian Healthcare Solutions, LLC/JF
• Novitas Solutions, Inc./JL & JH
• Palmetto GBA/J1 & J11
• Wisconsin Physicians Service Insurance Corporation/J5, J8, & T18

Since, the purpose of the CERT program is not to identify fraud; it utilizes the error rate findings to educate providers in the prevention of inaccurate claims for services that result in incorrect payments.  The Task Force is simply an extension of this goal, bringing together all the MACs to collaborate on mutual issues.

 Educational activity by the CERT A/B Contractor Task Force will be provided in addition to the existing materials offered by CMS, the Medicare Learning Network (MLN®), and the MACs within their jurisdictions.

  Educational materials from the CERT A/B Contractor Task Force will include this logo:

 The Plan: 

The Task Force will focus on one to four key subjects per year.
There will be periodic publications with detailed “coding scenarios” providing guidelines on preventing the applicable common errors.

Each MAC provides a dedicated page on their website for the CERT A/B Contractor Task Force and its communications.

 Watch for future announcements regarding upcoming activities from the CERT A/B Contractor Task Force.

Follow this link for access to all CMS published CERT reports.  By educating yourself, you can prevent billing errors that cause incorrect payments.