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Slight increase in DME errors mostly due to insufficient documentation

Slight increase in DME errors mostly due to insufficient documentation

WASHINGTON – The CERT error rate for DMEPOS is 31.8% for 2020, according to a recent report from Medicare. 

That's a slight increase of 0.8% over the previous year, according to an analysis by AAHomecare. Insufficient documentation is at the root of about 65% of errors, according to the “2020 Medicare Fee-For-Service Supplemental Improper Payment Data,” which reviewed claims from June 2018-June 2019. 

Medical necessity represented a small percentage of errors. Other types of errors include: no documentation, incorrect coding, and other unspecified errors. 

Error rates vary by category, with diabetic shoes (68.2%), lower limb orthoses (65.7%) and upper limb orthoses (42.3%) having the highest rates. 

Similar to previous years, power mobility devices have the lowest error rate, dropping to 4% from 7% in the 2020 report. The low error rate is attributed to prior authorizations. 

In January, the Office of Inspector General released a report that said CMS and its contractors did not use CERT data to identify providers with higher error rates. The agency recommended CMS review the list of 100 error-prone providers identified and take action such as prior authorization, prepayment reviews and post-payment reviews, and use annual CERT data to identify individual providers that have an increased risk of receiving improper payments and apply additional program integrity tools to these providers.  

CMS disagreed. 



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