Notice ID: CERTRC-240293
Description
CMS seeks to acquire a CERT Review Contractor (herein, “Contractor”) to, at a minimum:
- Select a stratified random selection of claims from the Medicare FFS claims universe
- Request medical records from the billing and ordering providers to support the claims billed
- Receive and process medical records for purposes of conducting medical review ( MR)
- Provide customer service support to the Medicare Administrative Contractors (MACs) and providers who have claims selected for review
- Conduct MR on claims selected for CERT and other accuracy reviews, as specified by CMS
- Communicate MR results to the MACs, providers, and other stakeholders
- Collect and transmit data to the CERT Statistical Contractor (CERT SC) for purposes of calculating improper payment rates
- Maintain various websites for internal and external stakeholders
- Establish mechanisms to manage, monitor and mitigate unexpected fluctuations in the Contractor’s workload
- Perform additional tasks to support the mandate of the CERT program, as directed by CMS and this Statement of Work (SOW)
