Comprehensive Error Rate Testing Program: Reduced Sample Size and Discarded Claims

The Comprehensive Error Rate Testing (CERT) Program has permanently reduced the sample size, starting with reporting year (RY) 2025. As a result of this reduction, some RY 2025 sampled claims may be removed or discarded.

If you have a claim that has been removed or discarded, it has been pulled from the sample and will no longer be used towards determining the error rate. MACs are required to adjudicate claims the CERT review contractor (RC) finds in error, regardless if the claim is later discarded. If the claim was found to be in error before it was discarded, and you disagree with the findings, you can appeal the denial. If the claim was discarded while still in the review process, the review will stop, and nothing further will be required.

Information can also be found on the CMS website - 2024-04-25-MLNC

Any further questions please email -

Last Updated Apr 29 , 2024