Tag: Comprehensive Error Rate Testing (CERT)
Improper payment rate drops
January 31, 2022HME News Staff
WASHINGTON – The improper payment rate for DMEPOS was 28.6% from July 2019 through June 2020, a 3.2% decrease from the prior year, according to the latest 2021 Medicare Fee-for-Service Supplemental Improper Payment Data Report from CMS. The improper payment rate varies by product category, AAHomecare pointed out in a bulletin, from 8.8% for power wheelchairs to 40.8% for enteral nutrition. CPAP devices and oxygen concentrators had improper payment rates of 30.8% and 22.3%, respectively. The...
SMRC reviews claims for surgical dressings
December 7, 2021HME News Staff
WASHINGTON – Noridian Healthcare Solutions, the Supplemental Medical Review Contractor for CMS, is conducting post-payment reviews of claims for surgical dressings billed on dates of service from Jan. 1, 2019, through Dec. 31, 2019. Surgical dressings are ranked in the top four categories with the highest improper payment rate at 62.8%, according to the 2019 Comprehensive Error Rate Testing Improper Payment Report. Medicare provides reimbursement for surgical dressings under the DMEPOS benefit,...
CMS adds CERT to reviews that are suspended
April 14, 2020HME News Staff
WASHINGTON - CMS will pause its CERT program, and will not send documentation request letters to or conduct phone calls with providers until further notice, according to AAHomecare. An original statement from the agency on March 30 stated MAC, SMRC and RAC reviews would be suspended during the public health emergency. The DME MACs also announced during a webinar last week that they would release all pending TPE reviews and would pay those claims, AAHomecare reports. Providers that have completed...
Improper payments for HME decrease
November 29, 2018HME News Staff
WASHINGTON - The improper payment rate for DMEPOS decreased from 46.2% in 2016 to 35.5% in 2018, representing a decrease of $1.14 billion, according to a bulletin from AAHomecare. The improper payment rate for all Medicare fee-for-service decreased from 9.5% in 2017 to 8.1% in 2018. The association met with CMS's Comprehensive Error Rate Testing team in June to explore ways to continue to improve error rates.
In brief: Apria ditches SEC reports, Invacare outsources IT
January 24, 2014HME News Staff
LAKE FOREST, Calif. - Apria Healthcare will no longer file reports with the Securities and Exchange Commission (SEC), according to a Form-8K dated Jan. 21. Apria was obligated to file periodic reports with the SEC pursuant to the terms of indenture governing the company's outstanding 12.375% senior secured notes due 2014. On Jan. 16, however, the company provided a notice of redemption for all of its notes and effected a satisfaction and discharge of the company's obligation under the indenture....
OIG to CMS: Review oversight process for CERT
January 20, 2014HME News Staff
BALTIMORE - The error rate reduction plans of Medicare claims administrator contractors are not always relevant to CERT results and vary substantially in number, according to a new report from the Office of Inspector General (OIG). CMS oversight of error rate reduction plans is limited and the staff that reviewed the plans may have been unable to determine whether the plans addressed their most recent CERT results, the OIG found. “Additionally, although some of the sampled plans did not include...
Providers avoid shortened timeframe
December 20, 2013Liz Beaulieu, Editor
WASHINGTON - It looks like the timeframe for responding to initial documentation requests as part of the Comprehensive Error Rate Testing (CERT) program will stand at 75 days.
CMS had planned to shorten the timeframe to 60 days, but Kim Brummett, senior director of regulatory affairs for AAHomecare, confirmed last week that the agency has tabled its plans indefinitely.
“I received word from the CERT coordinator that the change in the timeframe has been placed on hold until further notice,”...
MACs join forces to reduce denials
July 30, 2013HME News Staff
WASHINGTON - The Part A and Part B Medicare Administrative Contractors have formed a task force to educate on national issues of concern regarding improper payment errors, they have announced. The Comprehensive Error Rate Testing (CERT) A/B Contractor Task Force will hold its first teleconference Aug. 20. The task force affords providers the benefit of a “collaborative, consistent voice to reduce costly claim denials, as well as the CERT error rate,” according to a bulletin. The task...
Power wheelchair providers: There's more scrutiny under way
June 17, 2010Liz Beaulieu, Editor
From the it-should-have-been-reported-earlier-in-HME News files:
During Tuesday's CERT education call, officials talked about "supplemental measures" being taken on by the CERT contractor per Executive Order 13520, which was issued by President Obama way back in November. The goal of the order is "further intensifying efforts to eliminate payment error, waste, fraud and abuse in federal programs."
One of those supplemental measures: eight HCPCS codes for power wheelchairs. According to...