Comprehensive Error Rate Testing (CERT)
Guidance for effective August 11, 2020, the Centers for Medicare and Medicaid Services (CMS) is resuming Comprehensive Error Rate Testing (CERT) program activities that were temporarily suspended in response to the public health emergency (PHE) for the 2019-Novel Coronavirus (COVID-19) pandemic.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 11, 2020
******************************************************************************************************************
The COVID-19 public health emergency (PHE) expired on May 11, 2023. Claims with dates of service within the COVID-19 PHE were reviewed in accordance with all applicable CMS waivers and flexibilities.
If a provider or supplier receives a CERT documentation request, the provider or supplier should send the requested documentation to:
CERT Documentation Center
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Fax: 804-261-8100
Should a provider or supplier have questions on the documentation request or prefer the request to be made in a format other than a postal mailing, the CERT Documentation Center Customer Service may be contacted via:
Phone: 1-888-779-7477
Email: CertProvider@empower.ai
The CERT documentation requests identify that the requested documents are to be submitted within 45 calendar days of the request. However, the CERT program has the discretion to grant extensions to providers and suppliers who need more time to comply with the request. Providers and suppliers should contact the CERT Documentation Center Customer Service to identify any hardships or additional time needed with responding to a CERT documentation request.
We believe that this guidance is a statement of agency policy not subject to the notice and comment requirements of the Administrative Procedure Act (APA). 5 U.S.C. § 553(b)(A). For the same reasons explained above, the CMS additionally finds that, even if this guidance were subject to the public participation provisions of the APA, prior notice and comment for this guidance is impracticable, and there is good cause to issue this guidance without prior public comment and without a delayed effective date. 5 U.S.C. § 553(b)(B) & (d)(3).
*************************************************************************************************************
The Centers for Medicare & Medicaid Services (CMS) estimates the Medicare Fee-for-Service (FFS) program improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Each year, the CERT program reviews a statistically valid stratified random sample of Medicare FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules.
The fiscal year (FY) 2024 Medicare FFS estimated improper payment rate is 7.66 percent, representing $31.70 billion in improper payments. The table below outlines the improper payment rate and projected improper payment amount by claim type for FY 2024. The reporting period for this improper payment rate is July 1, 2022 through June 30, 2023.
| Claim Type | Improper Payment Rate | Improper Payment Amount (2) |
| Overall | 7.66% | $31.70 B |
| Part A Providers (excluding Hospital Inpatient Prospective Payment System (IPPS)) | 7.56% | $14.19 B |
| Part B Providers | 10.35% | $11.45 B |
| Hospital IPPS | 3.89% | $5.17 B |
| Durable Medical Equipment, Prosthetics, Orthotics, and Supplies | 21.41% | $1.92 B |
All public reports produced by the CERT program are available through the "CERT Reports" link on the left navigation. The improper payment rate is released annually in the Department of Health and Human Services (HHS) Agency Financial Report (AFR), which can be accessed through the HHS AFR link in the Related Links section at the bottom of this page.
(1) The national overall and hospital IPPS improper payment rates are adjusted for the impact of Part A to B rebilling of denied inpatient claims.
(2) Columns may not sum correctly due to rounding.
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.