You are using an outdated browser. Please upgrade your browser to improve your experience.
Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
Earn MOC points
The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
Prepare for the Certification and Maintenance of Certification (MOC)
Exam with an ACP review course.
Board Certification Review Courses
MOC Exam Prep Courses
Treating a patient? Researching a topic? Get answers now.
Visit AnnalsLearn More
Visit MKSAP 17 Learn More
Visit DynaMed Plus
Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration.
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
© Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572
Toll Free: (800) 523.1546 · Local: (215) 351.2400
CMS implemented the CERT program to measure improper payments in the Medicare fee-for-service (FFS) program. CERT is designed to comply with the Improper Payments Elimination and Recovery Act of 2010 (IPERA); Public Law 111-204. CERT randomly selects a statistical sample of approximately 50,000 claims submitted to Carriers, FIs, and MACs during each reporting period. Claims are reviewed to see if they comply with Medicare coverage, coding, and billing rules, and if not, errors are assigned to the claims.
The CERT Program uses two contractors to review claims and determine whether the claims were paid properly: the CERT Review Contractor and the CERT Documentation Contractor. The CERT Documentation Contractor is responsible for requesting medical records from health care providers that submitted the claims in the sample via a paper letter. When medical records are submitted by the provider, CERT Review contractors review the claims in the sample and the associated medical records to see if the claims complied with Medicare coverage, coding, and billing rules, and, if not, assigning errors to the claims. If medical records are not submitted, CERT classifies the case as a no documentation claim and counts it as an error. Reviews are conducted and claims determined to be paid incorrectly are scored as errors. Some common errors include:
Claims determined to be paid incorrectly are scored as errors and payments are adjusted. CERT sends providers overpayment letters/notices or make adjustments for claims that were overpaid or underpaid.
The CERT program cannot be considered a measure of fraud. Since the CERT program uses random samples to select claims, reviewers are often unable to see provider-billing patterns that indicate potential fraud when making payment determinations. The CERT program does not, and cannot, label a claim fraudulent. All public reports produced by the CERT program are available through the "CERT Reports".