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Revisions to Chapter 12 (The Comprehensive Error Rate Testing (CERT) Program) of Publication (Pub.) 100-08 (Medicare Program Integrity Manual) and Deletions to Exhibit 34 in the Exhibits Chapter of Pub. 100-08

The purpose of this Change Request (CR) is to revise various sections in Chapter 12 (The Comprehensive Error Rate Testing (CERT) Program) of Pub. 100-08. The revised section(s) include 12.5 (Handling Overpayments and Underpayments Resulting from the CERT Findings); 12.6 (Handling Appeals Resulting from CERT-Initiated Denials); 12.7 (Annual Certification of CERT Information); and 12.10.2 (No Response to Additional Documentation Requests). Additionally, grammatical and formatting changes as well as hyperlinks were updated throughout the chapter. This CR also deletes sub-exhibits within Exhibit 34 of Pub. 100-08 (Exhibits) that include Exhibit 34.2 (CERT Formats for Carrier and DMERC Standard Systems); Exhibit 34.6 (CERT PSC Contractor Feedback Data Entry Screen Version 1.01); and Exhibit 34.7 (Data Items Included on CERT Reports).

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Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 16, 2024

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.