The Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) Program to measure and improve the quality and accuracy of Medicare claims submission, processing, and payment. CERT was implemented to achieve the goals of the Government Performance and Results Act of 1993, which establishes performance measurement standards for Federal Agencies.

The CERT Contractor randomly selects a sample of claims from each Contractor for medical review by physicians, nurses, and other qualified healthcare practitioners to determine whether the claim was paid or denied correctly. The data is used by CMS to calculate a national paid claims error rate, a contractor specific error rate, services processed error rate (measures whether the Medicare contractor made appropriate payment decisions on claims) and a provider compliance error rate (measures how well providers prepared claims for submission).

Pinnacle Business Solutions, Inc. uses the CERT Program findings to determine underlying reasons for errors in claims payments and to implement appropriate corrective action as warranted to lower the error rate and improve the accuracy in the billing, processing, and payment of Medicare claims.

Please visit our CERT - Other Useful Web Sites Section for links to CERT information found on Government Health Care Sites such as CMS.

Recent Comprehensive Error Rate Testing Program Updates

Medicare Claim Review Programs Booklet Revised Friday, January 20, 2012 Attention Health Professionals: Information Regarding the Holding of 2012 Date-of-Service Claims for Services Paid Under the 2012 Medicare Physician Fee Schedule Monday, December 19, 2011 CMS Announces New Demonstrations to Help Curb Improper Medicare, Medicaid Payments Thursday, November 17, 2011 Medicare Pilot Project for Electronic Submission of Medical Documentation (esMD) Wednesday, October 19, 2011 Medicare Record Authentication – Tips for Physicians Wednesday, July 13, 2011 [Displaying Page 1] 2 3 4 Next Last