The Centers for Medicare & Medicaid Services (CMS) established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare Fee-For-Service (FFS) payments. The CERT program measures the error rate for claims submitted to A/B MACs, Carriers, Durable Medical Equipment Regional Carriers (DMERCs) and Fiscal Intermediaries (FIs).

CMS calculates the Medicare FFS error rate and estimate of improper claim payments using a methodology approved by the Department of Health and Human Services, Office of the Inspector General (OIG). The CERT methodology includes:

• Randomly selecting a sample of approximately 120,000 submitted claims
• Requesting medical records from providers who submitted the claims
• Reviewing the claims and medical records for compliance with Medicare coverage, coding and billing rules

View the CERT program public reports at www.cms.hhs.gov/CERT/.

Visit www.CERTprovider.org, which is a Web site run by the CERT documentation contractor, for monthly CERT newsletters, medical record request example letters and more.