Administrative Relief to Damaged Areas from a Disaster

12.13 – Administrative Relief to Damaged Areas from a Disaster (Rev. 12959; Issued: 11-14-24; Effective:12-17-24; Implementation: 12-17-24) 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.