Comprehensive Error Rate Testing (CERT) Program
The Centers for Medicare & Medicaid Services established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. One of the major outcomes of the CERT program is an annual paid claims error rate (percentage of dollars paid incorrectly). CGS uses information about top error categories to develop materials for providers, to help increase the accuracy of submitted claims.
Learn more about the CERT program through these resources:
- CMS Comprehensive Error Rate Testing Information, Data and Reports
- CERT Claim Identifier Tool
- CERT Public Website and Contact Information
Visit the CERT Provider website for information on submitting documentation, timelines, sample letters, and FAQs.
Appealing a CERT Error
A redetermination (1st level appeal) may be requested if you feel a CERT error was called incorrectly. Suppliers have the same appeal rights for CERT initiated denials as they do for denials initiated through CGS. When requesting a redetermination, be specific about why you feel the denial was incorrect. Send additional documentation and medical records that may be available to support the medical need for the item(s) denied. For more information about the appeals process, refer to the Appeals section of our website.
To find out more about what documentation may have been missing or why the error was called please access the JB DME MAC CERT Claim Identifier Tool.