CERT Audit & Investigation Process
What is CERT?
CERT is an acronym for Comprehensive Error Rate Testing, which was developed for the purpose of determining if contractors for Medicare paid claims in alignment with requirements. The Centers for Medicare and Medicaid Services, better known as CMS, leverages many tools for the purpose of identifying errors, fraud and overpayment through audits and investigations. The CERT audit and investigation process is quite extensive and provides a lot of feedback that’s valuable to Medicare Administrative Contractors (MACs) as they support the objectives of CMS.
The Role of MACs in the Reimbursement Process
MACs have played an expanded role in writing checks for the purpose of Medicare reimbursement. CERT auditors are intricately involved in the process of making sure reimbursements are accurate and handled appropriately by MACs throughout the Medicare system. In the event that a claim is found to have been reimbursed incorrectly, that issue is addressed throughout Medicare, which usually requires more audits.
