Outpatient Facility Coding Alert - 2009 Issue 19
DME ERRORS :CERT Error Rate Creates Difficulties for DME Suppliers -- Again
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Article Overview
This article examines a Medicare payment integrity issue affecting durable medical equipment suppliers, focusing on a 2008 CERT review and a related OIG report. It explains why different contractors reached very different error-rate results, summarizes the agencies’ positions, and notes proposed program integrity responses and review enhancements. The piece is relevant to DME suppliers, auditors, compliance staff, and coding/reimbursement professionals tracking Medicare documentation and medical-necessity review trends.
Why This Topic Matters
Understanding this report helps stakeholders assess how Medicare contractor review methods can affect error-rate findings, audit exposure, and broader compliance scrutiny in the DME sector. It also highlights how agency review procedures and documentation expectations may influence supplier risk and future oversight.
What You Will Learn
- How the Medicare CERT process was reviewed for durable medical equipment claims
- Why contractors reached different findings during claim review
- What the OIG recommended CMS do in response to the findings
- How CMS said it may adjust program integrity and review practices
Who Should Read This
- Durable medical equipment suppliers
- Medical coders
- Compliance professionals
- Revenue cycle staff
- Healthcare auditors
- Medicare reimbursement specialists
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