Comprehensive Error Rate Testing (CERT) checklists

• These checklists are intended to provide health care providers with a reference for use when responding to CERT documentation requests for the selected claim sample.

CERT Insider’s Guide

CERT Insider’s Guide

• Read the December edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.

CERT Insider’s Guide – Part A First Quarter 2025

• Read the Part A first quarter edition of the CERT Insider's Guide to learn more about claim errors assessed during the CERT review process and ways to mitigate these errors in the future.

SNF Spotlight

Medical necessity requirements for skilled nursing facility (SNF) admissions

• This questionnaire is intended to provide health care providers with a reference for use when screening a new patient for a SNF admission. This criteria is required to meet Medicare guidelines for a SNF covered stay and medical necessity.

SNF spotlight: CERT top denials for SNF reviews

• Here are the Comprehensive Error Rate Testing (CERT) top denial reasons for Skilled Nursing Facility (SNF) reviews.

SNF spotlight: Breakdown of Common Minimum Data Set (MDS) Errors

• The MDS is a tool used for implementing standardized assessment and for facilitating care management in skilled nursing homes and non-critical access hospital swing beds.
  • Breakdown of Common Minimum Data Set (MDS) Errors Section A to Section C
  • Breakdown of Common Minimum Data Set (MDS) Errors Sections D - E - GG
  • Breakdown of Common Minimum Data Set (MDS) Errors Section H to Section K
  • Breakdown of Common Minimum Data Set (MDS) Errors Section M to Section O and Section Z

Fast Facts

Fast facts: CERT claim sampling and review process

• Read this article for information about CERT claim sampling and the review process.

Fast facts: Appealing a CERT review decision

• Read this article for information about appealing your CERT claim review.

Fast facts: Checking the status of your CERT review

• This article has resources available for verifying the status of your CERT review.

Fast facts: CERT documentation submission

• Read this article to review some helpful information about the CERT program responding to additional documentation requests (ADRs).

Fast facts: Education on CERT error

• This article provides insights into the educational initiatives implemented following the assessment of a CERT error.