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Comprehensive Error Rate Testing (CERT)

The Centers for Medicare & Medicaid Services (CMS) calculates the Medicare Fee-for-Service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Each year, CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules.
 

The fiscal year (FY) 2013 Medicare FFS program improper payment rate is 10.1 percent, representing $36.0 billion in improper payments compared to the FY 2012 improper payment rate of 8.5 percent or $29.6 billion in improper payments. The table below outlines the improper payment rate and projected improper payment amount by claim type for FY 2013. The reporting period for this improper payment rate is July 1, 2011-June 30, 2012.

Service Type Improper Payment Rate Improper Payment Amount
 Inpatient Hospitals 8.0% $9.4B
 Durable Medical Equipment 58.2% $5.7B
 Physician/Lab/Ambulance 10.5% $9.5B
 Non-Inpatient Hospital Facilities 8.2% $11.4B
 Overall 10.1% $36.0B

 

All public reports produced by the CERT program are available through the "CERT Reports" link on the section navigation tray to the left.  The improper payment rate is released annually in the HHS AFR in the “Other Accompanying Information” section, which can be accessed through the HHS AFR link in the Related Links section at the bottom of this page.