Comprehensive Error Rate Testing (CERT)

CERT Quiz

1) CERT Is a Federal Program that:

a) Checks the common working file for incorrect HIC numbers
b) Monitors the claims paid by Medicare for accuracy of payments
c) Watches for fraudulent activities by providers and beneficiaries

2) CERT was instituted by:

a) Centers for Medicare and Medicaid Services (CMS)
b) United Government Services, LLC (UGS)
c) The Medicare Contractors (FI’s, DMERCs, and Carriers)

3) The claims reviewed by CERT are randomly selected, and records are requested from providers by the CDC. Who is the CDC?

a)CERT Documentation Contractor
b) Centers for Disease Control
c) Care Development Chief

4) After the medical records are obtained, the CDC sends them to the CRC for review. Who is the CRC?

a) Center for Contractor Reform
b) Chief Review Center
c) CERT Review Contractor

5) What should you do if your facility receives a documentation request letter from the CDC?

a) File it with the patient’s medical record
b)Contact the beneficiary for written permission to release the medical records
c) Take immediate action to respond to the request

6) What should you do if you cannot find the medical records requested by the CDC, or if the records are kept at a third party location?

a) Don’t do anything. If you can’t find them, there’s nothing you can do.
b) Respond to the CDC that someone else must have the records.
c) Contact the third party for the records immediately; advise the CDC of any delays in obtaining the records.

7) True or False - Medical records may be mailed or faxed to the CDC?

a) True
b) False

8) True or False - Denials made by the CERT program may be appealed through the regular appeals process.

a) True
b) False

9) True or False - Participation and cooperation with CERT is optional for providers.

a) True
b) False

10) True or False - Claim review by CERT is independent of targeted medical review by UGS.

a) True
b) False