CMS Issues A CERT Fact Sheet for Cardiac Pacemakers

As directed by the Improper Payment Information Act, the Centers for Medicare and Medicaid Services (CMS) established the Comprehensive Error Rate Testing (CERT) to monitor and report on the accuracy of Medicare Fee-For-Service (FFS) payments. The CERT program calculates the paid claims error rate for Medicare claims submitted to Carriers, Durable Medical Equipment (DMEPOS) Medicare Administrative Contractors (MAC) and Fiscal Intermediaries.

CMS calculates the Medicare Fee-For-Service error rate and estimates improper claim payments using an Office of the Inspector General (OIG) methodology that includes:

• Randomly selecting a sample of approximately 120,000 submitted claims
• Requesting medical records from providers who submitted the claims
• Reviewing the claims and medical records for compliance with Medicare coverage, coding and billing rules.

During its review, the CERT Program discovered a large number of errors related to the implantation of cardiac pacemakers, including dual chamber pacemaker implantation for a patient who is indicated for a single chamber pacemaker.

In an effort to reduce errors, CMS has issued a CERT Cardiac Pacemaker Factsheet which outlines the indications for a dual-chamber pacemaker that are established by the National Coverage Determination (NCD). Download the Factsheet(PDF, 484K).