Comprehensive Error Rate Testing (CERT)
The Centers for Medicare & Medicaid Services (CMS) has developed the Comprehensive Error Rate Testing (CERT) program to produce national, contractor specific, and service-specific paid claim error rates. The program has independent reviewers periodically reviewing random samples of Medicare claims that are identified as soon as they are accepted into the claims processing system at the Medicare contractors. The independent reviewers medically review claims that are paid and claims that are denied to ensure that the decision was appropriate.
The statutory authority for requesting medical records and claims information fall under Section 1833 (e), Title XVIII of the Social Security Act, which provides that you must supply such information as is necessary to determine whether Medicare payments are or were due under this title. Failure to comply with request for medical records will result in a denial and recovery of payments for all services provided on the dates in question.
If the requested information is not received within the specified time frame, CERT will assume that the services on the claim were not rendered and will direct us to pursue overpayment recoupment for these undocumented services.
- Who We Are
- About CERT/HIPAA
- CERT Documentation Contractor Process Flow Diagram
- CERT Review Process
- CERT Appeals
- CERT Articles
- Contact Information
- CERT Frequently Asked Questions
- CERT Newsletters
- CERT Sample Letters
- CERT Signature Tips (PDF - 74k)
- Electronic Signatures: What You Need to Know to Prevent Errors
- CERT Tips on How to Avoid Errors
- CERT Claim Identifier Tool
- CERT Web Training
- CMS CERT Information and Newsletters
- CMS CERT Web site
- CERT Provider Website
- Social Security Web site (refer to sections 1816 and 1832)
- Letters from CERT
- Error Rate Reports
- Submitting Documentation
