US · guidance
CMS Pub. 100-09, ch. 6, § 20.2.2
CERT Error Rate Reduction Analysis
MACs shall develop comprehensive education plans specifically focused on reducing the CERT
error rates. This analysis required integration of multiple data sources to create a complete
picture of error patterns and educational opportunities within the MACs jurisdiction. The
primary data sources include CERT program data (including inpatient claims error rates), RAC
program data, provider inquiry tracking data and claims submission error data.
To ensure effective error rate reduction, MACs shall maintain robust data analysis program that
use national data reports whenever CMS makes them available, as these provide valuable
benchmarking opportunities and identify nationwide trends. MACs shall also analyze local data
to pinpoint specific providers who drive unusual error patterns within their jurisdiction,
enabling targeted interventions where they will have the greatest impact.
History
(Rev. 13683; Issued: 04-08-26; Effective: 05-08-26; Implementation: 05-08-26)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ff212c1d54a4306712fcbb14f2582878c2e3d7c811225b48c475358bab999b57
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