tci Medicare Compliance & Reimbursement - 2008 Issue 31

Medical review: These OIG Recommendations May Make Life Harder

CMS will toughen up scrutiny for diabetic test strips, oxygen, and wheelchairs. After being called out on artificially lowering the DME payment error rate, the Centers for Medicare & Medicaid Services has agreed to implement most of these recommendations from the HHS Office of Inspector General: 1. Require the Comprehensive Error Rate Testing (CERT) contractor to review all available durable medical equipment supplier documentation. 2. Require the CERT contractor to review all medical records (including, but not limited to, physicians' records) necessary to determine compliance with applicable requirements on medical necessity. These first two recommendations will cost an additional...

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