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Comprehensive Error Rate Testing Program
The Centers for Medicare and Medicaid Services (CMS) implemented the
Comprehensive Error Rate Testing (CERT) Program to measure and improve
the quality and accuracy of Medicare claims submission, processing, and
payment. CERT was implemented to achieve the goals of the Government
Performance and Results Act of 1993, which establishes performance
measurement standards for Federal Agencies.
The CERT Contractor randomly selects a sample of claims from each
Contractor for medical review by physicians, nurses, and other qualified
healthcare practitioners to determine whether the claim was paid or
denied correctly. The data is used by CMS to calculate a national paid
claims error rate, a contractor specific error rate, services processed
error rate (measures whether the Medicare contractor made appropriate
payment decisions on claims) and a provider compliance error rate
(measures how well providers prepared claims for submission).
Pinnacle Business Solutions, Inc. uses the CERT Program findings to
determine underlying reasons for errors in claims payments and to
implement appropriate corrective action as warranted to lower the error
rate and improve the accuracy in the billing, processing, and payment of
Medicare claims.
Please visit our CERT - Other Useful Web Sites Section for links to CERT information found on Government Health Care Sites such as CMS.
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