General Question for the Week of September 24, 2018

General Compliance Question of the Week

Question:

What is the purpose of the Medicare CERT program?

Answer:

The Centers for Medicare & Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare fee-for-service (FFS) program. CERT selects a random sampling of claim types to request and review medical documentation to determine if the services were paid appropriately. If the criteria for coverage are not met or the provider fails to submit medical documentation to support the claim, the payment is recouped from the provider, and an error is assessed to the contractor for that paid claim.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.