Comprehensive Error Rate Testing Program

1
Comprehensive Error Rate Testing Program

• CERT

2
Medicare Fee for Service

• National Error Rate
• CERT and HPMP rates
• CERT
• FI, Carrier and DMAC
• HPMP
• QIOs
• Error rate 60/40 respectively

3
CERT

• Randomly select _at_ 120,000 claims
• Request Medical Records
• Review for Compliance
• Coverage
• Coding
• Billing
• National Program, former OIG process

4
CERT Contractors

• Levanta (Advanta Medical Solutions)
• CDC
• AdvanceMed
• CRC

5
CERT Process

• Records Request
• CDC
• Post Pay
• Address (www.certprovider.org)
• Review
• CRC
• Additional records request
• Adjustments
• Local contractor
• Bill type XXH

6
Reports and Appeal Process

• Subject to same Appeal process as Medical Review
  determinations
• Two Reports
• November-Annual report
• May-Interim report
• Public reports www.cms.hhs.gov/cert

7
Goals

• National Error Rate goal for 2006 5.1 (overall
  goal, CERT and HPMP)
• Current ASF FI 2.6
• Current ASF Carrier
• Current ASF DMAC
• Current National Error rate

8
Questions