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Claims review programs

Learn key information about the Comprehensive Error Rate Testing (CERT) program, including how this post-payment claim review program measures national, contractor-specific, and service-specific paid claim error rates, and why CERT is important to providers.
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Discover why the nation’s leading Medicare administrative contractors (MAC) have joined together to create the CERT A/B MAC Outreach & Education Task Force and how its unified educational initiative will benefit providers as well as the Medicare program.
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Find useful information about the Inpatient Medicare severity-related diagnosis-related groups (MS-DRG) initiative, including how it is an integral part of the inpatient prospective payment system (IPPS).
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Learn about the Medically Unlikely Edits (MUE) prepayment-claims review program, which is designed to reduce errors resulting from clerical entries and incorrect coding based on the maximum units of service (UOS) that would be reported for a procedure code on the vast majority of appropriately reported claims.
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Learn how the National Correct Coding Initiative (NCCI) prepayment claim review program helps CMS promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.
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Find out how the recovery audit program utilizes claim reviews to reduce the volume of improper payments within the Medicare program as well as to identify process improvements to reduce future improper payments.
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.