Comprehensive Error Rate Testing
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Comprehensive Error Rate Testing 2010
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Leaders Health Plans Community & Rural Marketing HR Intelligence Reports Exchanges Exchange Insight Reports Whitepapers Fact File Executive Insight Center Roundtables Webinars Career Center CA Healthfax Digital Magazine Sign up for e-Newsletters Shop Advertise Contact NewsNews & Analysis eNewsletter Signup AnalysisLeadership Finance Technology Quality Physician Leaders Nurse Leaders Health Plans Community & Rural Marketing HR MagazineArchives Subscribe Renew Change Address ResearchIntelligence Reports Buzz Surveys Council Chief Executive Quarterly Briefings ExchangesOverview CEO CFO CNO Population Health Revenue Cycle Physician Organizations Exchange Insight Reports Sponsorship EventsHLM Live Webinars ResourcesWhitepapers Fact File Executive Insight Center Roundtables Webinars Industry Focus Reports Career Center ShopWebinars eConferences Leadership Guides Insider Reports Books Physician Executive Series Advertise AboutTeam Awards Privacy Policy Terms of Use Reprints Contact RAC vs. CERT Audits: Do You Know the Difference?HealthLeaders Media Staff, November 11, 2009 The Comprehensive Error Rate Testing (CERT) Hospital Payment Monitoring Program is one of the ways CMS is trying to improve the quality and accuracy of Medicare claim submission and payment of those claims. Is that so different from what the RAC program is designed to do? While the end-goal may be the same, the methodology is very different. Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City, outlines some of the important differences between the two types of Medicare audits: Who is being audited. RACs look for errors made by providers, but the CERT is looking for errors in payments made by carriers. Hospitals and other providers are affected because when the CERT looks into a claim, the provider must submit the medical records, and if the CERT uncovers an error, the CERT will take back money from the hospital. But the CERT is really looking for errors made by fiscal intermediaries, Medicare administrative contractors or other carriers when paying providers' Medicare claims. Education. "CERTs want to make sure everything is on the up and up for the claims," Levitt explains. When the patterns of incorrectly paid claims appear on its radar, the CERT steps in and educates providers. RACs don't provide such education. Payment. RACs are paid through contingency fees. The more under- or over-payments they uncover, the more money they receive. The payment for CERTs is different; they receive a set amount outlined in their contra