Claims compliance and review
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Inpatient hospital short stay reviews
Inpatient hospital short stay patient status reviews for acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities.
CERT Insider’s Guide – Part A Fourth Quarter 2025
Read the fourth quarter edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.
Breakdown of common Minimum Data Set (MDS) errors: Sections M - O & Z
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.
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.
Breakdown of common Minimum Data Set (MDS) errors: Sections M - O & Z
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.
Fast facts: CERT comparative analysis reports
Read this article for information about the CERT comparative analysis reports.
Physical therapy plan of care requirements
When billing for rehabilitation therapy services, there are some documentation requirements that must be met to comply with the reasonable and necessary definition.
CERT Insider's Guide - Part B Fourth Quarter 2025
Read the fourth quarter edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.
Fast facts: CERT comparative analysis reports
Read this article for information about the CERT comparative analysis reports.