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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.
CPT® copyright 2023 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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