Podiatry Alert: Here’s What Caused $330 Million in Improper Payments for Part B and DMEPOS

We’ve talked about CERT 2017 report results before in this blog, but that’s mostly been Part B. Podiatry coders need to be thinking about DMEPOS, too. And based on the 70.5 percent error rate estimated for podiatry under DMEPOS, practices need to put that on their priority lists.

Review the CERT Report Stats

The “2017 Medicare Fee-for-Service Supplemental Improper Payment Data” report measures improper payments through the Comprehensive Error Tate Testing (CERT) program. The numbers are estimates based on a sampling of claims reviewed. The time period for the FY 2017 Medicare FFS improper payment rate is July 1, 2015, to June 30, 2016, to allow time for review and rate calculation.

Here are some numbers to know for podiatry:

Improper payment rates for Part B for podiatry

  • Projected improper payments: $254,763,597
  • Improper payment rate: 15.2%
  • Improper payment percent by error type
    • Insufficient documentation: 80%
    • Medical necessity: 0.4%
    • Incorrect coding: 19.6%

Improper payment rates for DMEPOS for podiatry

  • Projected improper payments: $74,985,875
  • Improper payment rate: 70.5%
  • Improper payment percent by error type
    • Insufficient documentation: 80%
    • Medical necessity: 5.4%
    • Other: 14.6%

Don’t Let DMEPOS Be Your Downfall

The CERT 70.5 percent improper payment rate for DMEPOS is a good place to start when looking for areas to improve. Podiatry Coding & Billing Alert recently posted some pointers based on a DME CERT Outreach and Education Task Force webinar.

Because insufficient documentation was the major error type, here are some areas to watch:

  1. Make sure you can access documentation that supports the patient’s need for items (like orthotics) the podiatrist provides.
  2. Consider whether documentation from others in addition to the ordering physician will accomplish what you need. Hospitals, nursing homes, and home health are some possibilities.
  3. If you’ve got orthotists and prosthetists on staff, train for documentation that supports the types of components and necessary modifications involved.

Keep in mind: Where you focus most of your attention for improvements also needs to factor in how much you report to Part B vs. DMEPOS. In other words, DMEPOS-related improvements are important, but don’t neglect documentation and claims for Part B, which is likely responsible for much more of your revenue. Incorrect coding was a factor for Part B, so be sure to brush up on compliant coding for your top services, including E/M. As one last stat to go out on, CERT projected $42, 223, 531 in improper payments for office visits for podiatry, an 11.1 percent error rate, which is much higher than the 5.5 percent error rate calculated overall for all provider types.

What About You?

How do you handle claims when there’s insufficient documentation? Do you find DME compliance especially tough?



Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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