Submitting Medical Records
If you are selected for a CERT review what should you do?
Requests for records from the CERT Contractor do not pose any HIPAA vulnerabilitities and must receive prompt attention. Respond to all requests for information from the CDC within the timeframe allotted. You will receive a request letter that includes a "pull list sorted alphabetically by patient surname; and bar-coded cover sheets that include control numbers, which correspond to each record identified on the pull list for the claims requested. Include any medical record requested by the CDC as indicated in the request letter. The documentation will be reviewed by the CDC to determine if the service is supported in the medical record. The request from the CDC is a generic form letter and may not list all of the items needed to arrive at a correct decision. We recommend you review the Documentation Guidelines list we've developed to identify other records that should be sent. This list is available on our web site at: http://www.wpsmedicare.com
Steps to follow when submitting medical records to the CDC for CERT.
1) Photocopy each record (verify you are submitting records for the correct date of service)
2) Make sure all copies are complete, legible, and contain both sides of each page, including page edges
3) Complete copies should include specific records to support the services on the claim(s) identified on the pull list, and include all documentation that supports medical necessity of the service as billed on the claim
4) Complete the bar-coded supplied cover sheet for each record (if the bar coded sheet is not available write the CERT Claim ID (CID) number on each page of the documentation)
5) Attach the completed bar-coded cover sheet to the corresponding photocopied chart and fax to the CERT Documentation Contractor (CDC) at (240) 568-6222.
Voluminous pages can be mailed to:
CERT Documentation Office
9090 Junction Drive Suite 9
Annapolis, MD 20701
Note: Follow all instructions indicated in the request letter.
Do we have to obtain beneficiary authorization to release medical information to the CERT Contractor (AdvanceMed)?
No. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits disclosure of personal health information to carry out treatment, payment or health care operations. When Medicare beneficiaries enroll in the program they are informed of Medicare's use of their personal health information to carry out health care operations. The CDC performs health care operations as a business associate of The Centers for Medicare & Medicaid Services (CMS) with respect the HIPAA Privacy Rule. Providing the requested documentation does not violate the minimum necessary provision of the HIPAA Privacy Rule and does not require beneficiary authorization.
Page Last Updated: Thursday, 18-Mar-2010 05:48:27 CDT
