Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Providers' Responsiveness to Requests for Medical Records Under the Comprehensive Error Rate Testing Program," (A-01-04-00517)

September 29, 2004

Complete Text of Report is available in PDF format (1.38 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


Our review, conducted in response to congressional concerns, determined that Centers for Medicare and Medicaid Services has made excellent progress in obtaining medical records by reducing the provider nonresponse rate to less than 1 percent of the number and dollar value of claims included in the Comprehensive Error Rate Testing (CERT) FY 2004 sample.  We do not believe that the remaining nonresponses will have a significant effect on the reliability of CMS’s estimate of the Fiscal Year 2004 Medicare fee-for-service paid claims error rate.  Our report discusses reasons cited by providers for the nonresponses.