CMS Comprehensive Error Rate Testing (CERT) Program
The Lewin Group helped CMS develop the program by which it determines the accuracy of Medicare payments made to providers. CERT is based on sampling Medicare claims as they enter the processing systems, reviewing them, and calculating an error rate. The Lewin Group serves as the statistical contractor for this program, developing the algorithms for sampling claims, and calculating the payment error rate. An overall payment error rate is reported. In addition, error rates for different components of Medicare and for different services are calculated. This rate satisfies the requirements of the Improper Payments Information Act of 2002, and is reported by CMS to OMB and Congress.
The Lewin Group helps policymakers design, implement, and evaluate Medicare policies and programs, and helps health plans and providers understand and adapt to Medicare policies.
Medicare is the nation’s largest health insurance program covering more than forty million Americans. The Lewin Group offers specialized expertise in Medicare policy, a longstanding relationship with The Centers for Medicare & Medicaid Services (CMS), and a thirty-year history of policy analysis involving federal programs in general and Medicare in particular. Several members of The Lewin Group staff were former CMS employees or employees of other federal government programs.
Our work is designed to help the Medicare program reduce its costs, pay providers fairly, and ensure that services are delivered more efficiently and effectively.
Services
The Lewin Group helps the federal government, providers, and health plans analyze Medicare policy proposals, design and evaluate programs, and assess performance. It brings the provider and plan perspective in its assistance to the government, and insight and understanding of Medicare policies in its assistance to plans and providers.
Policy Analysis and Modeling
- Analyze CMS provider payment methodologies
- Evaluate financial and operational impacts of proposed policy changes
- Study quality performance measurement and pay-for-performance programs
Program Design and Evaluation
- Design Medicare risk and incentive programs
- Develop and evaluate demonstration programs
- Assess payment integrity
Performance Assessment
- Evaluate beneficiary utilization and satisfaction
- Design, deliver, and evaluate provider education and training
- Conduct feasibility and cost/benefit studies