Fast facts: CERT comparative analysis reports

The Comprehensive Error Rate Testing (CERT) review contractor (RC) randomly selects a statistically valid sample of Medicare fee-for-service claims and reviews those claims for payment errors. The CERT program considers any payment that should not have been made or that was paid at an incorrect amount (including both overpayments and underpayments) to be an improper payment. 

A comparative analysis is provided solely for educational purposes and is not intended to suggest any wrongdoing by you or your practice. It is a resource to help you review your billing patterns and, if you choose, conduct an internal audit. No response to this letter is required.

The top right square displays national improper payment rates, while the bottom left section lists common reasons claims may be denied by CERT.

The “number of billed services” reflects the units billed for the code under the specified PTAN. “Peers” refers to other providers within your jurisdiction who bill the same code. Codes are selected based on national improper payment rates, with the overall goal of reducing the error rates through education.

We encourage providers to bill accurately for services rendered and ensure that documentation appropriately supports all billed services.