Majority of DMEPOS Improper Payments Due to Insufficient Documentation

WASHINGTON, D.C. (August 16, 2017)—Last month, CMS published the annual Medicare Fee-For-Service Improper Payments Report. CMS reports that for dates of service between July 2014–June 2015, the error rate for DMEPOS was 46 percent, which is an increase of 7 percent from the previous year. For the report, 10,999 DMEPOS claims were reviewed. However, CMS states that the majority of this rate is attributed to insufficient documentation and not due to medical necessity. Insufficient documentation errors account for 80.4 percent of the DMEPOS improper payments. Many of the documentation issues were due to inadequate face-to-face, physician signature and proof of delivery.

The majority (31.5 percent) of the DMEPOS improper payment rate fell under the following DME categories:

• Oxygen supplies and equipment
• Positive airway pressure devices
• Lower limb orthoses

CMS states that in order to reduce the DMEPOS improper payment rate, ordering physicians must respond to supplier requests for documentation.

You can find the report here.

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