Comprehensive Error Rate Testing (CERT)
Shyam Sunder , 12-Feb-2025
Comprehensive Error Rate Testing (CERT) Medicare's Comprehensive Error Rate Testing (CERT) is a program run by the Centers for Medicare & Medicaid Services (CMS) to monitor the accuracy of Medicare fee-for-service payments by randomly reviewing a sample of claims submitted by providers to determine if they were paid correctly according to Medicare rules, essentially identifying improper payments made on claims that may have been fully or partially denied or paid at an incorrect level based on submitted documentation.
Key points about CERT:
• Purpose: To estimate the overall improper payment rate in the Medicare program by reviewing a statistically valid sample of claims across different claim types.
• Process: A CERT contractor selects a random sample of Medicare claims and reviews them for errors in coding, medical necessity, documentation, and billing practices.
• Impact on providers: If a provider has a high error rate identified through CERT, it could lead to potential audits, payment adjustments, or other corrective actions.
• Reporting: CMS publishes the overall improper payment rate based on CERT findings, which is used to track the effectiveness of Medicare payment accuracy initiatives.
