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RAC vs. CERT Audits: Do You Know the Difference?

By HealthLeaders Media Staff  
   November 11, 2009

However, there are some similarities between the two programs. Both auditors report to CMS. And both will recoup money from hospitals and other providers who received overpayments.

Providers can also appeal any claims they believe were wrongly denied by a RAC or CERT. The process for RAC appeals has been widely discussed, but providers can also go through the appeal process for a CERT denial. "It's not just a de facto takeback," Levitt says.

In addition, CERTs will still use OIG statistical methodology. "They're still bound to that just like the RAC is—for example if a RAC wants to extrapolate," she says. "Everybody is held to the same statistical standard such as the OIG statistic program, RATSTATS."

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