CMS Pub. 100-08, ch. 12, § 12.13

This section applies to Medicare Administrative Contractors (MACs) and Comprehensive

Error Rate Testing (CERT) as indicated.

A. General

In the event of a disaster, the CERT program shall grant temporary administrative relief to

any affected providers and suppliers. The administrative relief available to the CERT

program is discussed below.

B. Definition of a Disaster

A disaster is defined as any natural or man-made catastrophe (e.g., hurricane, tornado,

earthquake, volcanic eruption, mudslide, snowstorm, tsunami, terrorist attack, bombing,

fire, flood, explosion, etc.) which causes damage of sufficient severity and magnitude to

partially or completely destroy medical records and associated documentation that could

be requested by the CERT review contractor in the course of medical review, interrupt

normal mail service (including US Postal delivery, overnight parcel delivery services,

etc.), and/or otherwise significantly limit the provider or supplier’s daily operations. A

disaster may be widespread and impact multiple structures (e.g., a regional flood) or

isolated and impact a single site only (e.g., water main failure).

A provider or supplier must submit a disaster attestation (available on the CERT public

website https://c3hub.certrc.cms.gov/ and upon request) when the documentation

requested to support a claim has been wholly or partially destroyed in a disaster. The

CERT review contractor shall accept an attestation that no medical records exist due to a

disaster.

C. Administrative Relief

Once a disaster has been declared, CMS will notify the CERT review contractor to grant

temporary administrative relief to those providers or suppliers in areas that have been

declared a disaster by the Secretary of the Department of Health and Human Services.

Please refer to the CMS Emergency Response and Recovery website at

https://www.cms.gov/about-cms/what-we-do/emergency-response for information on

current and past emergencies.

The CERT review contractor shall apply administrative relief along with flexibilities and

waivers related to medical review at the direction of CMS. The administrative relief is to

be granted to affected providers and suppliers in accordance with the following

guidelines:

• The CERT review contractor shall not send any additional documentation

requests (ADRs) or attempt telephone calls to request medical documentation on

claims, as directed by CMS, to providers and suppliers affected by the disaster as

determined by locations listed on the CMS Emergency Response and Recovery

website or as determined by CMS. This administrative relief starts on the date the

disaster is effective.

• Administrative relief does not include claims that have completed CERT review

before the administrative relief began.

• Administrative relief is applied to entities when the physical location or mailing

address of the provider or supplier is in the area impacted by the disaster.

• If at any time documentation is received from the provider or supplier for claims

impacted by administrative relief, the CERT review contractor will proceed with

review.

The MACs may obtain a list of claims impacted by administrative relief in the Claims

Status Section on the C3HUB.