Twice a month the CERT contractor sends a
file to CGS that includes all the claims found to
be in error. The claims are randomly assigned
for audit. CGS adjusts the claims based on
whether the error resulted in an overpayment
or underpayment. The provider will receive
a Remittance Notice for each adjustment
made. CGS will also request refunds on errors
that resulted in overpayments and will issue
additional payments if claims are underpaid.
Needless to say, the majority of claims are for
overpayments.
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Pedorthic Footcare Association www.pedorthics.org
If an error is not found after the claim is
reviewed by the CERT contractor, no response
will be sent to the provider. The status of any
claims sent to the CERT contractor can be
checked by accessing the CERT Claim Identifier
Tool. The tool may be accessed on the CGS
website at:
HTTP://CGSMEDICARE.COM/MEDICARE_
DYNAMIC/CID_TOOL/SEARCH.ASP
If the provider disagrees with a CERT initiated
denial, the decision may be appealed. The same
Photo: @Shutterstock.com/KWJPHOTOART
"THIS CERT CLAIM IDENTIFIER TOOL HAS BEEN DESIGNED TO AID
MEDICARE SUPPLIERS OBTAIN THE RESULTS OF THEIR CERT REVIEW."