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Comprehensive Error Rate Testing (CERT)

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) 2016 Medicare FFS program improper payment rate is 11.00 percent, representing $41.08 billion in improper payments, compared to the FY 2015 improper payment rate of 12.09 percent or $43.33 billion in improper payments (1). The table below outlines the improper payment rate and projected improper payment amount by claim type for FY 2016. The reporting period for this improper payment rate is July 1, 2014 -June 30, 2015.

Service Type

Improper Payment Rate

Improper Payment Amount (2)

Overall

11.00%

$41.08

Part A Providers (excluding Inpatient PPS Hospitals)

13.98%

$22.01B

Part B Providers (Physicians/Labs/Ambulance)

11.71%

$10.93B

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

46.26%

$3.73B

Inpatient PPS Hospitals

3.85%

$4.42B

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 Department of Health and Human Services (HHS) Agency Financial Report (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.

(1) The national overall and inpatient hospital improper payment rates are adjusted for the impact of Part A to B rebilling of denied inpatient claims.  

(2) Columns may not sum correctly due to rounding.

Updated: September 27, 2016

On August 16, 2016, CMS awarded the CERT Review Contractor work to AdvanceMed, an NCI company.  This new contract eliminates the current CERT Documentation Contractor as of October 13, 2016.   The work that is currently being performed by the incumbent Documentation Contractor will be transitioned to the Review Contractor and fully operational on October 14, 2016.   

Important information for this transition is as follows:

  •  October 6, 2016 is the last day that the current CERT Documentation Contractor will be receiving medical records and CERT inquiries at their location
  •  Beginning with October 7, 2016, all CERT inquires and medical records are to be sent to the following:    

CERT Documentation Center
1510 East Parham Road
Henrico, VA 23228
Fax: 804-261-8100
Customer Service: 443-663-2699
Toll Free:  888-779-7477
Email: certmail@admedcorp.com

  • Beginning with October 7, 2016, the website addresses will remain the same:   
    1. Public Website--https://www.certprovider.com will remain in use as the official web address
    2. MAC Website--https://www.certdoc.org-will remain active temporarily and take users to the existing CERT Claim Status web site where new features have been added
    3. Provider Address update-the functionality to accept provider address updates will not be available from October 6, 2016 through October 13, 2016.