Signature Guidelines for Home Health & Hospice Medical Review

The Center for Medicare Services (CMS) implemented the Cert Program to measure improper payments in the Medicare Fee-For-Service (FFS) Program. Under the CERT Program, a random sample of all Medicare FFS claims are reviewed to determine if they were paid properly under Medicare coverage, coding, and billing rules. Two contractors manage the CERT Program, the CERT Statistical Contractor (CERT SC) and the CERT Review Contractor (CERT RC). The CERT SC determines Medicare claims sampling and calculates the improper payment.