General

For the Week of March 20, 2017

What is the purpose of the Medicare CERT program?

The Comprehensive Error Rate Testing (CERT) Program estimates improper payments in the Medicare fee-for-service (FFS) program. CERT reviewers evaluate a random sample of all Medicare FFS claims to determine if they met Medicare coverage, coding, and billing rules. Once the CERT Program identifies a claim as part of the sample, it requests the associated medical records and other pertinent documentation from the provider or supplier who submitted the claim. Medical review professionals check the submitted documentation to see if the claim was paid or denied appropriately.