The Comprehensive Error Rate Testing (CERT) Process for Handling a Provider’s Allegation of Medical Record Destruction
Impact to You
SE 0547 outlines the process Medicare providers should follow when medical records requested by Medicare's Comprehensive Error Rate Testing (CERT) Documentation Contractor (CDC) and/or Medicare's CERT Review Contractor (CRC) are destroyed by disaster.
What You Need to Know
For CERT purposes, a 'disaster' is defined as any natural or man-made catastrophe, which causes damages of sufficient severity and magnitude to partially or completely destroy or delay access to medical records and associated documentation.
- Natural disasters would include hurricanes, tornadoes, earthquakes, volcanic eruptions, fires, mudslides, snowstorms and tsunamis
- Man-made disasters would include terrorist attacks, bombings, floods caused by manmade actions, civil disorders and explosions. A disaster may be widespread or impact multiple structures or be isolated and impact a single site only.
What You Need to Do
If you cannot submit the requested medical records because they were destroyed by a disaster, the CDC/CRC will ask you to attest, under penalty of perjury, to the destruction of the medical records. The Attestation Form is available to providers at www.certprovider.org. Providers who need to use this form can print and fax the form to the CDC who will either retain the form or send it to the CRC depending on which contractor sent the initial request letter for medical record documentation to the provider.
Background
The Centers for Medicare & Medicaid Services (CMS) recognizes that there are circumstances in which destruction of medical record documentation because of unforeseen events should not count as a 'no documentation error.' Therefore, CMS has established the following process and procedures to corroborate allegations that CERT-requested medical records were destroyed by a disaster.
The corroboration process is comprised of two steps: 1) qualification and 2) accuracy. In the first step, the CDC/CRC will review the attestation statement to determine if the event qualifies as a disaster.
Provider induced disasters and disasters caused by negligence on the part of providers will be counted as 'no documentation errors.'
The following are examples of provider induced disasters and disasters caused by negligence on the part of providers that would not qualify as a natural or man-made disaster:
- My dog ate the medical record
- My computer lost or destroyed the medical record
If the event does not qualify as a natural or man-made disaster defined in the Provider Action Needed section of this article, the claim associated with that medical record is documented as a 'no documentation error.'
The following are examples of events that would qualify as a natural or man-made disaster:
- The medical record was destroyed by a flood
- Office fire consumed the medical record
If the event does qualify as a natural or man-made disaster, the CDC/CRC will move to the second step in the corroboration process: confirming the accuracy of the attestation. The CDC will confirm the attestation statement through any or all of the following means:
The CDC checks the following database records for evidence of natural, man-made and/or provider induced disasters: Pacer (Civil and Criminal Searches), Crimetime.com, News Searches, Internet Search, HHS OIG Sanctioned Providers, Merlin, State Record Searches (Courthouse Records), Insurance Carriers or www.insurancefraud.org/ Choicepoint /Autotrak, Argyli, Tracer and the National Crime Insurance Bureau).
The CDC interviews the provider who reported the destruction of medical records. The CDC determines the events leading up to the destruction of medical records, such as: what caused the destruction (weather, fire, etc.), were back-up records maintained (electronic or otherwise), what else might have been destroyed, were fire, police, insurance adjusters called to review the damage? The CDC will identify the magnitude of the destruction to medical records, determine if the Medicare Carrier/DMERC/FI has copies, interview other third parties as necessary and determine if medical records were retained elsewhere and how were they maintained.
The CDC validates additional supporting evidence for the event, which may include but not be limited to the following sources:
- Weather related events, such as, rain, floods, hurricanes, tornadoes, etc., that can be confirmed by NOAA on a state and county geographical basis
- Fire that can be confirmed by checking with the local Fire Marshall
- Explosions, such as, natural gas that can be confirmed by the local Fire Marshall or local gas company
- Explosions, such as, chemical explosions that can be confirmed by the local Fire Marshall and the Bureau of Alcohol, Tobacco and Firearms
- Local, stat, and federal investigative officials can confirm explosions
- State insurance officials can confirm whether doctors, hospitals and DME suppliers applied for insurance coverage under their insurance policies
- FEMA can confirm if doctors, hospitals and DME suppliers applied for disaster recovery loans
- Local and state investigative agencies may be able to confirm events leading to the destruction of medical records
- Employees or non employees of doctors, hospitals and DME suppliers may have contributed to the destruction of medical records and there should be records disclosing charges against that individual(s)
Where the CDC is unable to verify the accuracy of the explanation provided in the attestation statement, the claim will be counted as a 'no documentation error.' Please note that this could eventually lead to a determination that an overpayment has occurred and overpayment recovery action could result.
Additional Information
MLN Matters article MM2976 (PDF, 75 KB) describes the CERT program and MM3812 (PDF, 84 KB) provides additional information on CERT.
If you have questions, please contact us at (866) 332-7025.