Comprehensive Error Rate Testing (CERT)

Centers for Medicare & Medicaid Services (CMS) established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. Palmetto GBA uses CERT reports to identify areas of focus for our Provider Outreach and Education efforts. One of the major outcomes of these CERT reports is the paid claims error rate (percentage of dollars paid incorrectly).

From this web page, you may view CERT error rates by code group and provider type (specialty), articles about specific areas of concern as a result of CERT review findings, and newsletters from the CERT documentation contractor (CERT DC). 

More Information About CERT

Also, providers may designate a specific point of contact to receive CERT information in your billing or medical records office. Please click on the link below and update the point of contact information for your facility. This is important in ensuring that the correct CERT request is received as soon as possible by the contact person to avoid the CERT review from being routed to various departments within each Part A facility.

Establish a CERT contact person for your practice at the CERT provider website.

Comprehensive Error Rate Testing (CERT) Articles

CERT: Inpatient Psychiatric Facility ChecklistProvider Minute: Physician Orders/Intent to Order Laboratory Services and Other Diagnostic ServicesCERT Provider Sample LettersCERT Ambulance ChecklistCERT: Skilled Nursing Facility ChecklistCERT: Part A ChecklistInpatient Admission Documentation ChecklistPatient Discharge Status Codes MatterComprehensive Error Rate Testing (CERT) Teaching and Instruction for Providers (TIP) Letters from Medical ReviewDRG 207 - Respiratory System Diagnoses with Ventilator SupportOutpatient Therapy and Rehabilitation Services Documentation ChecklistDRG 460 - Spinal FusionComprehensive Error Rate Testing (CERT) Question and Answer Fact SheetInpatient Rehab Facilities (IRFs) Common CERT Error CodesMedicare Part A Payments for End-Stage Renal Disease Dialysis Services and Comprehensive Error Rate Testing (CERT)CERT Error: Insufficient DocumentationDRG 003 - Mechanical VentilationDRG 453, 454 and 455 - Combined Anterior/Posterior Spinal FusionCERT Contractor Email AddressesDRG 056 - Degenerative Nervous System Disorders with MCC and DRG 057 - Degenerative Nervous System Disorders without MCCDRG 981, 982 and 983DRG 518 - Back and Neck ProceduresDRG 092 - Other Disorders of Nervous System with Complication Or Comorbidity W/CCVerify Your CERT Contact InformationDo You Know What Your Comprehensive Error Rate Testing (CERT) Contractor Is Looking For?What is a Comparative Billing Report?DRG 266 and DRG 267 - Endovascular Cardiac Valve ReplacementDRG 312 - Syncope and CollapseDRG 884 (Psychoses) and DRG 885 (Organic Disturbances and Mental Retardation)Comprehensive Error Rate Testing (CERT) Identified Errors for TelehealthDRG 627 - Thyroid, Parathyroid and Thyroglossal procedureDRG 493 - Lower Extremity and Humerus ProceduresDRG 556 - Signs and Symptoms of Musculoskeletal System and Connective TissueCERT Appeals: Providing DocumentationDRG 313 - Chest PainCERT Documentation Request ListingsCERT Error: Incorrect CodingMedicare Providers: What You Need to Know About Signatures & DocumentationMS-DRG 552 - Medical Back Problems without MCCHEAT Provider Compliance Training VideosDRG 948 - Signs and Symptoms w/o MCCDRG 560 - Aftercare, Musculoskeletal System and Connective Tissue with Complication or Comorbidity (CC)DRG 227 - Cardiac Defibrillator Implant without Cardiac Catheterization without MCCDRG 517 - Other Musculoskeletal System and Connective Tissue O.R. ProceduresDRG 193, 194 and 195 - Simple Pneumonia and PleurisyAdditional Guidance on Electronic Signatures Is AvailableLack of Documentation Affects Provider ReimbursementRequested CERT Documentation Located at Another FacilityStamped Signatures Not Acceptable!Diagnostic Test Order Needed to Support a Service for the Interpretation of a Diagnostic TestRespond to All CERT RequestsAsk Questions, Be InformedSubmitting Complete and Legible Medical Records is Key!Documenting Specific Services in the Medical RecordDocumenting Is Critical!Do you know if the CERT Contractor differs from the Medicare Administrative Contractor?What Can You Expect to Receive from the CERT Contractor?Signatures, Credentials and Dates: They Are ImportantKnow the Purpose of the CERT ContractorCMS Contractors Verify ComplianceMedicare Does Not Accept Retroactive OrdersOrders for Tests Must Be SignedLack of Signature Could Affect Provider ReimbursementCERT Decisions May be AppealedDocumenting the Patient's Progress in the Medical RecordA Legible Medical Record MattersCreate a Signature LogPhysician Signatures Missing on Medical Records: CERT TipCERT Follow-up Record RequestsAuthentication Matters!Top CERT ErrorsHow to Avoid Denials for Inpatient Transcatheter Aortic Valve Replacement (TAVR) ServicesHow to Avoid Denials for Inpatient Transcatheter Aortic Valve Replacement (TAVR) ServicesDRG 682 - Renal Failure with Major Complication or Comorbidity (MCC)Complying with Medicare Signature RequirementsFrom the Desk of the MAC Medical Directors: Caring for Medicare Patients is a PartnershipCaring for Medicare Patients is a PartnershipComplying with Documentation Requirements for Laboratory ServicesCaring for Medicare Patients is a PartnershipOutpatient Rehabilitation Therapy Services: Complying with Documentation RequirementsCMS Provider Minute: The Importance of Proper Documentation VideoProvider Minute: Utilizing Your MACCERT A/B MAC Outreach & Education Task Force: Emphasis on Outreach & Education to Reduce ErrorsComplying With Medical Record Documentation RequirementsCMS Provider Minute: The Importance of Proper Documentation VideoEntries in Medical Records: Amendments, Corrections and AddendaIntroduction to CERT Web Based TrainingComprehensive Error Rate Testing (CERT) Errors : Critical Access Hospitals (CAH)Appeal Errors Identified by the Comprehensive Error Rate Testing (CERT) Program