The Comprehensive Error Rate Testing (CERT) Program

12.1 – The Comprehensive Error Rate Testing (CERT) Program (Rev. 13678; Issued: 03-12-26; Effective: 04-13-26; Implementation: 04-13-26) The Comprehensive Error Rate Testing (CERT) program produces a national Medicare Fee- for-Service (FFS) improper payment rate that is compliant with the Payment Integrity Information Act of 2019 (PIIA) and the implementing guidance in the Office of Management and Budget Circular A-123, Appendix C. The CERT program evaluates a stratified random sample of Medicare FFS claims to determine if they were paid or denied properly under Medicare coverage, coding, and billing rules. The CERT program considers any payment for a claim that should have been denied or that was made in the wrong amount (including both overpayments and underpayments) to be an improper payment. The claim can be counted as either a total or a partial improper payment, depending on the error. The findings can be projected to the entire universe of Medicare FFS claims because the CERT program ensures a statistically valid random sample. Therefore, the improper payment rate calculated from this sample is reflective of all claims processed by the Medicare FFS program during the report period. The results of the improper payment rate calculation are published annually in the Department of Health and Human Services Agency Financial Report, and the CMS Financial Report. More information about the CERT program is available at https://www.cms.gov/data-research/monitoring-programs/improper-payment- measurement-programs/comprehensive-error-rate-testing-cert.