In August 2000, the Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) Program. Through the CERT Program, a CMS Program Safeguard Contractor (PSC), AdvanceMed, selects a random sample of claims (approximately 200/month) from each contractor (carrier/fiscal intermediary/durable medical equipment regional carrier) for medical review. AdvanceMed uses existing Medicare guidelines, as well as contractor Local Coverage Determinations (LCDs), technical edits, and processing guidelines to identify errors, i.e., claims billed, paid, or processed incorrectly. Through the information collected, national and contractor specific error rates are produced. CMS and contractors are able to use the error rates and data abstracted to determine the root causes of errors in the billing, payment, and/or processing of Medicare claims. With this information, Highmark Medicare Services is able to target its resources and take corrective action as warranted.

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