Jamie Bennet 
- CMS awarded Serco a $109 million contract to review a randomized sample of claims for the agency’s Comprehensive Error Rate Testing program
- The seven-year contract will be performed virtually and at Serco’s locations using artificial intelligence and a team of medical reviewers
- CERT was implemented to quantify improper Medicare Fee-for-Service payment rates
The Centers for Medicare and Medicaid Services has awarded Serco Inc. a seven-year, $109 million contract to be the review contractor for the agency’s Comprehensive Error Rate Testing program, the company announced Monday.
“Serco provides actionable insights to CMS to help educate providers, enhance oversight, and strengthen program integrity,” said Michael LaRouche, Serco Inc. CEO and a three-time Wash100 Award winner. “Our decade-long partnership with CMS and our proven ability to leverage technology to improve efficiency, making us a vital partner in ensuring the sustainability of critical health programs for the American people,” he added.
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What Is the CERT Program?
The Comprehensive Error Rate Testing program was established to calibrate the improper payment rates in the Medicare Fee-for-Service program in terms of contractor and type of contractor, service or provider. Medicare FFS processes nearly 70 million Americans’ medical expenditures worth more than $1 trillion every year. CERT gets about 37,500 claims from durable medical equipment and Part A/B Medicare administrative contractors through stratified random sampling.
What Are the Terms of the Contract?
Under the contract, Serco’s team will validate Medicare FFS claims and ensure their compliance with the Payment Integrity Information Act of 2019, as well as other coding, billing and insurance coverage rules. The review team, which will perform their tasks virtually from Serco’s facilities, will use a combination of artificial intelligence, intelligent document processing and medical experts. The contract expands CMS’ collaboration with Serco, which has been serving the agency for more than 12 years.
