Health Policy Affairs

Centers for Medicare and Medicaid Services (CMS) established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. One of the major outcomes of these CERT reports is the paid claims error rate (percentage of dollars paid incorrectly).

The CERT review contractor issues an additional documentation request (ADR) to obtain medical records for each claim line sampled for CERT review. The CERT review contractor initial letter request schedule has changed. Beginning with review year (RY) 2026 providers will only have 60 days to respond to these requests and if no records have been submitted, your claim will be denied for non-response. Responding within 45 days, if not before, is always best practice to ensure timeliness.

Providers may designate a specific point of contact (POC) to receive CERT information in your facility. We strongly encourage you to ensure your designated CERT POC is up to date. This is important in ensuring that the CERT request is received as soon as possible by the correct person and to avoid being routed to various departments within your facility. You can reach the CERT office at (888) 779–7477 to verify or make changes to this information.