CERT (Comprehensive Error Rate Testing)

WHAT IS "CERT"?

CERT is the Comprehensive Error Rate Testing program, instituted by the Centers for Medicare and Medicaid Services (CMS). CERT monitors the accuracy of Medicare payments of claims submitted to Fiscal Intermediaries (FI’s), carriers, & DMERCs. A separate program, the Hospital Payment Monitoring Program (HPMP) is responsible for monitoring payments to inpatient acute care hospitals.

CERT calculates error rates and estimates improper claim payments using a methodology approved by the Office of the Inspector General (OIG). The CERT methodology includes:

• Randomly selecting a sample of claims submitted to Carriers, DMERCs, and FIs to Medicare during a specific year
• Requesting medical records from the providers who submitted the claims
• Reviewing the claims and medical records for compliance with Medicare coverage, coding, and billing rules
• Scoring claims as errors when the providers failed to submit documentation
• Sending providers overpayment letters/notices or making adjustments for claims that were overpaid or underpaid.

Please note that the CERT Program is independent from any medical review conducted by UGS, LLC.