I was giving a presentation recently on the Comprehensive Error Rate Testing Program, or CERT. This is a study conducted annually by the Centers for Medicare & Medicaid Services (CMS) that, in effect, measures the error rate found for claims that have been previously approved and paid by Medicare.
For 2015, the CERT study reported on the findings of reviews for 49,603 claims that encompassed Part A, Part B, and DMEPOS services. Of these, they found that 12.1 percent were paid in error, of which 11.7 percent were flagged as overpaid and 0.4 percent, or $1.3 billion, were flagged as underpaid.
As in the past when giving this presentation, I didn’t even talk about the underpaid metric because it seemed mostly irrelevant based on both the rate and my own experience at adjusting underpayment. And that is how I continued to view this until quite recently.