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Thorough understanding of the CERT program is necessary to fix error rates

The Comprehensive Error Rate Testing (CERT) is a program used by the Centers for Medicare & Medicaid Services (CMS) for calculating the rate or extent of improper payments of Medicare Fee-for-Service (FFS). The method used by the CMS under CERT is to pick up a stratified random sample of some 40,000 claims that are statistically valid and calculate and audit it to determine if the payments were made in accordance with the rules relevant to items such as coding, Medicare coverage, and billing rules.

These claims are selected from the submissions made to Part A or Part B Medicare Administrative Contractors (MACs) and Durable Medical Equipment MACs (DMACs) during each reporting period. This sample is deemed as being adequately representative of the universe and is considered a good enough indicator of the method by which improper payments can be calculated for the whole system.

For the 2016 fiscal year, the CMS arrived at Medicare FFS program improper payment rate of 11.00 percent. This means that as much as $41.08 billion was made in improper payments. This represented a slight dip over the previous fiscal year, in which the improper payment rate was 12.09 percent, meaning that a high volume of $43.33 billion was made in improper payments.

Knowing CERT is important

Having knowledge of the CERT is necessary for players in the healthcare industry, as anyone of them can be picked up from the statistically valid random sample that the CMS chooses from to audit for checking improper payments. How do these entities make sure they are properly equipped to deal with the CERT program?

A webinar from MentorHealth, a leading provider of professional trainings for the healthcare industry, will seek to answer this. At this session, Gail Madison Brown, a Registered Nurse and an attorney who has focused on health care compliance and revenue cycle management operations for the last 15 years, will be the speaker. To gain full knowledge of how to comply with CERT, please register for this webinar by logging on to

Full exploration of CERT and its functioning

To understand the nitty-gritty of the way the CERT is designed and works. This comprehensive learning about the CERT program will equip participants with the knowledge needed for ensuring compliance with billing and healthcare operations, so that their organization does not get hauled up by the CMS for improper payments. The way in which this program affects the organization and its reimbursement will be taken up for discussion. She will arm the participants with prevention strategies with which they can improve compliance.

Gail will take up these topics at this webinar:

1. Summary of the CERT program and how it affects healthcare providers

2. Improper payment measurement history

3. CERT process and how to respond

4. Prevention Strategies

Those in compliance, audit, billing and coding, and other professionals engaged in operational strategies will find this course highly useful. Gail will cover the following areas at this session:

  • CERT program -what it does and who if affects
  • History and trends of improper payments
  • How the CERT process works and how you need to respond, including what documentation to provide
  • Understand types of improper payment categories and implement strategies to prevent further CERT requests and demands -No documentation, insufficient documentation, medical necessity, incorrect coding and other issues.

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