Review of CERT Errors Overturned Through the Appeals Process for Fiscal Years 2009 and 2010

oig.hhs.gov: 03-09-2012.

CMS established the Comprehensive Error Rate Testing (CERT) program to produce a national Medicare fee-for-service (FFS) error rate. An error is the difference between the amount that Medicare paid to a health care provider and the amount that it should have paid. Using the results of the CERT program, CMS annually submits to Congress an estimate of the amount of improper payments for Medicare FFS claims, pursuant to the Improper Payments Information Act of 2002. Providers have the right to appeal claim payment denials made by the CERT review contractor. Appeal decisions made after the cutoff period for determining the error rate are not reflected in improper payments report estimates. Read More