decisionhealth Newsletters, Part B News - 2008 Issue 9 (September)
OIG audit shows CMS vastly underestimated DME errors
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Article Overview
This article covers a federal audit of CMS’s durable medical equipment error-rate findings, the OIG’s concerns about the review methodology, and CMS’s response. It also discusses agency and lawmaker reactions, the types of documentation and review practices involved, and later changes CMS made to its CERT process. The piece is relevant to professionals tracking Medicare program integrity, audit findings, and claims documentation policy.
Why This Topic Matters
It highlights a significant discrepancy in reported Medicare DME error rates and shows how audit findings can influence documentation review practices, contractor oversight, and CMS policy changes.
What You Will Learn
- What the audit examined and why it drew attention
- How the reported DME error rate compared with the earlier CMS figure
- What kinds of methodology and documentation issues were raised
- How CMS and lawmakers responded to the audit
- What changes CMS later made to its CERT review approach
Who Should Read This
- Medical coders
- Billing professionals
- Compliance officers
- DME suppliers
- Medicare policy analysts
- Healthcare auditors
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