Comprehensive Error Rate Testing (CERT)
CERT is a program developed by Centers for Medicare and Medicaid Services (CMS) which randomly audits claims monthly to determine if they processed correctly. Contractors then use this information to determine the cause of errors working to resolve them. CERT was designed to comply with the Improper Payments Elimination and Recovery Act of 2010 (IPERA).
To gain insight into the causes of claim errors, CMS calculates a provider compliance error rate (which measures how well providers prepared claims for submission) and a services processed error rate (which measures whether the Carrier/DMERC/FI made appropriate payment decisions on claims) in addition to the national paid claims error rate. CMS CERT site
CMS has contracted with AdvanceMed to perform random audits of chart notes and medical reports to verify the accuracy of claims payment. Click here to see a sample CERT request form.
For more CERT information click on the linkes below:
1. CMS
2. Noridian