The Comprehensive Error Rate Testing Program

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Note:  The following article synopsis was NOT provided by BC Advantage. It was created by Find-A-Code/innoviHealth.

Article Overview

This article discusses the CMS Comprehensive Error Rate Testing (CERT) program and its role in measuring Medicare Fee-For-Service claim error rates. It explains the general audit-risk context in which CERT data is used, describes the types of claim review activities involved, and highlights how the study’s results can be applied by compliance, auditing, and analytics professionals. The article is relevant to readers who work with Medicare claims, audit planning, coding oversight, and risk assessment.

Why This Topic Matters

CERT data can help organizations understand where Medicare claims are more likely to be reviewed, why payments may be found improper, and how audit-risk profiling is informed by national error-rate trends.

What You Will Learn

  • What the CERT program is and why CMS uses it
  • How Medicare claim error-rate studies support audit-risk analysis
  • What broad categories of claim-payment issues are tracked in CERT reporting
  • How compliance and audit teams may use error-rate information for planning

Who Should Read This

  • Medical coders
  • Compliance officers
  • Audit and recovery professionals
  • Practice administrators
  • Healthcare analytics professionals
  • Medicare billing staff

Codes Discussed


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