The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2011 report period (claims submitted January 1, 2010 through December 31, 2010). These claims were used to calculate the FY 2011 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.