CERT Program: Chapter 12 and Exhibit 46 Revised — Update Documentation Protocols by August 28
CMS Transmittal R13890PI revises CERT Program Chapter 12 and Exhibit 46, requiring updated medical record submission protocols before August 28, 2026.
Action required by
August 28, 2026
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
CMS Transmittal R13890PI revises Chapter 12 of the Medicare Program Integrity Manual—governing the Comprehensive Error Rate Testing (CERT) Program—along with Exhibit 46, with an implementation date of August 28, 2026. This is an administrative transmittal, not a Final Rule or LCD. The single most important compliance implication: any organization that receives CERT medical record requests must verify its internal response and documentation protocols reflect the revised Chapter 12 requirements before August 28, 2026, or risk improper payment findings tied to documentation deficiencies rather than clinical ones.
Regulatory Background
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Quick answers
Does Transmittal R13890PI affect how we respond to CERT requests for both Part A and Part B claims?
Yes. The CERT Program samples across Medicare fee-for-service claims broadly, which includes both Part A (institutional) and Part B (professional) claim types. The Chapter 12 revision applies to CERT Program operations generally. Review the full transmittal at the CMS source URL to determine whether any claim-type-specific submission distinctions are introduced in the revised Exhibit 46.
If we have a CERT request already in process before August 28, 2026, which version of Chapter 12 applies?
The transmittal implementation date is August 28, 2026. CERT requests received and responded to before that date would follow the prior Chapter 12 guidance. For requests that span the implementation date—received before but responded to on or after August 28—verify with your MAC or the CERT contractor which version governs your submission, as the transmittal source does not specify transition handling for in-flight requests.
Is Exhibit 46 a standalone document we need to obtain separately, or is it embedded in Chapter 12?
Exhibit 46 is published as part of the Medicare Program Integrity Manual Chapter 12 framework. Access the revised version directly through the transmittal link at https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13890pi to obtain the current exhibit text. Do not rely on a locally saved or prior-version copy of Exhibit 46 for submissions made on or after August 28, 2026.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.