Medicare Compliance & Reimbursement

OIG checks in to see who is -- and who is not -- handing over the files. Still haven't sent in the medical records the Comprehensive Error Rate Testing contractor requested? The Centers for Medicare & Medicaid Services is seeing that you do. Larger than expected numbers of providers failed to respond to CERT requests for medical records in determining the 2003 fee-for-service claims error rate. That's why Senate Finance Committee Chairman Chuck Grassley (R-IA) and other members of Congress weighed in at the HHS Office of Inspector General with a request for get a reliable number in 2004. This year, CMS's improvements included more training of its CERT contractors and a new automated mailing system. The changes have apparently helped. AJune 2 OIG audit titled "Review of Corrective Actions To Improve the Comprehensive Error Rate Testing Process for Obtaining Medical Records" (A-03-04-00005), determined that provider responsiveness has improved in the first three quarters of this year. However, more may need to be done. The report also says as of April 8 that providers had still failed to submit medical records for 2,239 of the 126,618 claims sampled. The OIG says that it has begun an in-depth review to determine why many providers failed to respond despite repeated requests for records. Here are some little known but all-important facts about the CERT process:

sending medical records to CERT contractors is permissible under Health Insurance Portability and Accountability Act;
medical records can be faxed directly to CERT contractor; and
new Internet-based claims tracking system allows CMS and CERT contractors weekly status updates of the review process to help identify non-respondent providers. To read the report, go to http://www.oig.hhs.gov/oas/reports/region3/30400005.pdf.