| AdvanceMed Corporation was awarded the Comprehensive Error Rate Testing (CERT) program in 2001.The CERT program measures the error rate for claims submitted to Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (FIs). The Hospital Payment Monitoring Program (HPMP) measures the error rate for the Quality Improvement Organizations (QIOs). These two rates are combined to measure the overall Medicare Fee-for-Service (FFS) payment error rate. CMS calculates the Medicare FFS error rate and estimates of improper claim payments using a methodology the OIG approved. The CERT methodology includes:
CMS, Office of Financial Management (OFM), Program Integrity Group (PIG), Division of Methods and Strategy developed a program called the Comprehensive Error Rate Testing (CERT) program that will produce national, contractor specific, benefit category specific and provider specific paid claim error rates. The program calls for independent reviewers to periodically review a systematic random sample of claims that are identified after they are accepted into the claims processing system at carriers and intermediaries. These sampled claims are then followed through the system to their final disposition. Claims that are paid are medically reviewed by the independent reviewers; those claims that are denied are validated by the independent reviewers to ensure that the decision was appropriate. The decisions of the independent reviewers are entered into a tracking database. Annual reports are produced that provide the basis for program planning, evaluation and corrective actions.
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| Client Centers for Medicare & Medicaid Services (CMS) |
| Location Richmond, VA and Baltimore, MD |
| Program Manager John Simpson simpsonj@admedcorp.com |