CERT report shows improper payment increase

WASHINGTON – The Centers for Medicare and Medicaid Services (CMS) recently published the 2025 Comprehensive Error Rate Testing (CERT) Improper Payment Report which shows an increase in improper payments for DMEPOS for the first time since 2015. The 2025 improper payment rate for DMEPOS was reported to be 24.1%, which is a 2.7% increase since the previous year, according to a bulletin from AAHomecare. The 2025 report data is based on claims analyzed from July 1, 2023, to June 30, 2024. AAHomecare reviews the report in detail each year to help educate the supplier community on specific policy groups and supplier types that have higher improper payment rates.  In addition, AAHomecare continues to have discussions with CMS and the DME MACs on audit opportunities based on the report.   

DME MACs to conduct prepayment reviews for new urological suppliers  

Due to the high improper payment rate reported in the 2025 CERT report, the DME MACs for Jurisdictions B and C have announced they will be conducting a widespread pre-payment review of urological supplies submitted by new suppliers.   
  
Only new suppliers will be pursued. The DME MACs will be sending additional documentation requests (ADR) for impacted claims. The ADR will include requests for the following items before the DME MACs will pay for the claim:   

• Treating practitioner's written order.  
• Relevant medical records that support it is medically necessary to perform intermittent catheterization.  
• Any other pertinent documentation.  
• Copy of Advance Beneficiary Notice (ABN) if one was obtained.  

Additionally, for sterile intermittent catheter kits, medical records must document that the beneficiary meets one of the coverage criteria listed in the Urological Supplies Local Coverage Determination specific to sterile intermittent catheter kits.  

You can find the announcement on CGS’s website.