Medicare Says It Overpaid for 40 Percent of DMEPOS Claims in 2015

Written by: Kimberly Commito on Monday, June 13, 2016 Posted in: HME/DME

DME blog-01The Council for Medicare Integrity (CMI) announced last month that Medicare lost $3.2 billion in 2015 due to payments to suppliers for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) that were deemed improper. Reportedly, the erroneous payments occurred because nearly 40% of DMEPOS claims contained errors – most commonly, insufficient documentation.

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According to Comprehensive Error Rate Testing (CERT) reviewers, documentation errors accounted for $2.6 billion of the DMEPOS overpayments. The reviewers concluded that payments were “improper” for these claims because the documentation failed to support – perhaps because it lacked important elements like physician signatures – that the billed services were medically necessary or even provided.

With Medicare’s insolvency estimated to occur by 2030, the pressure to reduce Medicare payment errors is significant. And with the new Recovery Audit Contractors (RAC) shining a spotlight specifically on DMEPOS claims, providers must take extra caution with documentation. You can’t afford any missing details.

Sending complete documentation doesn’t have to be a difficult challenge. See how CareTend’s paperless documentation ensures that you have met all of the requirements for clean claim submission without the headache.


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