Insufficient Documentation No. 1 Reason for CERT Denials

WASHINGTON, D.C. (July 14, 2016)—Last year, AAHomecare began meeting with CMS’s CERT contractor oversight team to discuss efforts to lower the DMEPOS industry’s CERT error rate. In 2010, the DMEPOS CERT error rate was at an all-time high of 73.8 percent. As of 2015, the error rate has decreased to 39.9 percent. In an effort to better understand the driving force of the error rate, AAHomecare submitted a FOIA request for detailed data on the denial reasons. After reviewing the data, AAHomecare discovered that insufficient documentation was the most common reason for a CERT denial. Roughly 83 percent of CERT denials can be attributed to insufficient documentation.

You can find the details of AAHomecare’s analysis here. In addition, the CERT error rate tracking sheet can be found here.