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Linda Collins Blogger

CERT Error Report for Lower Limb Orthoses

Posted by Linda Collins | August 14, 2017

CMS has released the latest CERT Error Report. Per the report, the payment accuracy rate – the percentage of Medicare FFS dollars paid incorrectly - was 89.0 percent. This percentage is for all claim types including hospitals.

Lack of documentation remains one of the main causes of improper payment. This means the reviewer did not have adequate documentation, from the supplier and physician, to conclude the product was delivered, billed correctly, or was medically necessary. Insufficient documentation errors accounted for 80.4% of improper payments DMEPOS claims.

Lower Limb Orthoses claims accounted for some of the highest errors. The CERT reports the improper payment rate for these claims was 69.6%, accounting for $241 million dollars.  

Based upon these findings, the CERT and MACs will continue audits on lower limb orthoses claims.

What does this mean for you?

Work with referring physicians to educate them on the appropriate documentation. The study indicate referring physician specialties of General Surgery, Internal Medicine, and Family Practice accounted for the highest documentation error rate. Work with referring physicians to educate them on the appropriate documentation.  Documentation provided by the supplier of the product is not sufficient. All medical necessity criteria must be corroborated in the physician's medical records.

Be familiar with the medical necessity criteria for lower limb orthosis. You may download reimbursement guides for lower limb orthoses here.

Read the full CERT report here.

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