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April 6, 2021

Insufficient Documentation of Surgical Dressings to be Addressed in National Webinar on April 15, 2021

Data from the 2020 Comprehensive Error Rate Testing (CERT) Report shows that surgical dressings ranks #3 on the list of top Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) items with CERT errors during the reporting period. To address these error trends and provide information on documentation requirements for surgical dressings, the DME CERT Outreach and Education Task Force will conduct a national webinar on April 15, 2021, at 2 pm ET/1 pm CT.

The CERT contractor reviewed 461 claims for surgical dressings with dates of service from July 1, 2018 through June 30, 2019. Based on their review, the improper payment rate for surgical dressings claims was calculated at 67.3%, with projected improper payments of $194,901,082.

The following diagram is a visual representation of improper payments by type of error:

Pie graph for PAP Device and Accessory Errors Just over one half Medical records, followed by quarter sections for Delivery, Orders and NPI, then a small section for Billing

Current error trends of claims denied due to insufficient documentation show that medical records lack the following items:

  • Information regarding the location, number, and size of qualifying wounds being treated with a dressing
  • Whether the dressing is being used as a primary or secondary dressing or for some non-covered use (such as wound cleansing)
  • Amount of drainage

Coverage and documentation requirements for surgical dressings can be reviewed on the following links:

Additional information about the CERT data is available on the CMS websiteExternal Website.

We encourage all suppliers of surgical dressings to attend this free webinar and learn about how to prevent these errors. Together, we can reduce CERT errors!

Register for this national webinar at: Website


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