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Gov’t audit insider: CERT program coming for your records

Healthcare Auditing Weekly, June 22, 2004

The Office of Inspector General (OIG) is cleaning house-and you could be swept into the mess. The OIG has reviewed the Comprehensive Error Rate Testing (CERT) program-which collects a random sample of records from various healthcare facilities. The Centers for Medicare & Medicaid Services (CMS) uses the data to build an error rate for all facilities other than inpatient hospitals. <P>

But CMS had difficulty collecting the records from providers in 2003, according to an OIG audit report released June 16. Almost 2,300 providers have not submitted requested records to the CERT program, the audit report says. This skewed the initial calculations for the error rate. As a result, the OIG may ask CMS to take actions to improve the collection rate. If your facility is among the group that didn't fulfill a CERT request for records, you may see an OIG or CMS auditor at your door soon.<p>

To review CMS' improvements to the CERT program, the OIG performed the following tasks:

• Performed a limited review of CERT internal controls
• Reviewed CMS internal controls and revised policies and procedures related to the audit objective
• Examined CMS' improvements to the CERT program to gauge its effect on provider response
• Interviewed CERT personnel

Click here to view the audit report called "Review of Corrective Actions to Improve the Comprehensive Error Rate Testing Process for Obtaining Medical Records."

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