How are claims evaluated according to CERT?

Claims are evaluated according to the Comprehensive Error Rate Testing (CERT) program through a process that involves national review by contractors. This method is designed to assess the accuracy of Medicare claims and provide insights into potential areas for improvement in billing practices. By employing a national approach, contractors can ensure consistency and standardization in evaluating claims, which helps in identifying and addressing errors across the healthcare system.

This nationwide review allows for a broader sampling of claims, leading to more comprehensive data analyses. It ensures that findings are reflective of the overall performance in submitting claims, rather than being limited to specific regions or service types. Consequently, the national review by contractors is pivotal in maintaining the integrity of the Medicare program and enhancing compliance. The focus on systematic assessment rather than a narrow scope strengthens the effectiveness of the compliance evaluation process.