In an ongoing effort to educate providers regarding the CERT program and prevent unnecessary denials of services, the Part A Medical Review Department is expanding our TIP letter process to include denials made by the CERT contractor.

When the CERT contractor has made a decision to partially or fully deny a claim based on coverage or billing issues, providers will receive an individual CERT TIP letter for each claim denial.

The CERT TIP Letter was created to:

• Enhance the provider's knowledge regarding the CERT program;
  
  
• Provide education specific to the denial reason;
  
  
• Provide suggestions to prevent similar denials from occurring in the future;
  
  
• Provide information regarding the appeal process.

The CERT TIP Letter will include the following:

• Comprehensive article regarding the CERT program;
  
  
• Provider's appeal rights for the CERT process;
  
  
• Pertinent Web site and/or reference information regarding the CERT program and coverage issues.

The Medical Review Department published an article about the CERT program on the Palmetto GBA Web site. This article titled The ABCs of the Comprehensive Error Rate Testing (CERT) Program and How to Respond to CERT Requests includes a checklist for skilled nursing facility, outpatient, home health and hospice providers to use when responding to CERT Requests. To access this article from the Palmetto GBA Home Page:

1. Go to http://www.PalmettoGBA.com/rhhi

2. Select CERT from the far left column (third heading from the top under the Providers section.)

3. Select  the "+" sign next to General Infomation.

4. Select The ABCs of the Comprehensive Error Rate Testing (CERT) Program and How to Respond to CERT Requests (Revised March 2008)

If you have any questions regarding the CERT TIP letter or CERT program in general, please contact the Part A Medical Review Department at 803-763-7491.

NOTE - These letters are to be used for educational purposes only. It is not a denial notification for appeals purposes.