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March 27, 2018


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Medical Coding News Archives

OIG Recommendation to CMS: Expand CERT Review Process

 
September 23, 2008:

In an August 22 report, the Office of Inspector General recommended that the Centers for Medicare & Medicaid Services expand the review process for its Comprehensive Error Rate Testing program to ensure accurate measurement of payment errors for durable medical equipment, prosthetics, orthotics and supplies (DME POS).

The report indicates that for fiscal 2006, there was a DME error rate of 7.5 percent, or about $700 million in improper payments. This was calculated after contractor review of records requested from DME suppliers, including physician orders, certificates of medical necessity, and proof-of-delivery documentation. In independent reviews of fiscal 2006 claims, the OIG found an error rate of up to 29 percent, or about four times the error rate reported by CMS

The OIG report recommends that the CERT contractor review all medical records to determine compliance with medical necessity requirements and to contact patients who have high-risk claims, such as those for power mobility devices, to determine whether they received the items and if the items were medically necessary. The report further states CMS has generally concurred with the OIG recommendations.

 

 
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