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October 15, 2021

Insufficient Documentation of Knee Orthoses to be Addressed in National Webinar on November 3, 2021

Data from the 2020 Comprehensive Error Rate Testing (CERT) Report shows that lower limb orthoses rank #1 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 knee orthoses, the DME CERT Outreach and Education Task Force will conduct a national webinar on November 3, 2021, at 2 pm ET/1 pm CT. Registration is currently openExternal website.

The CERT contractor reviewed 794 claims for lower limb orthoses submitted from July 1, 2018 through June 30, 2019. Based on their review, the improper payment rate for lower limb orthoses claims was calculated at 65.7%, with projected improper payments of $501,651,014.

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

LLO Errors

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

  • Medical documentation that supports an examination of knee instability and an objective description of joint laxity (such as joint testing, anterior draw, posterior draw, or valgus/varus test) from the treating practitioner
  • Supplier documentation does not include sufficiently detailed description of the modifications necessary at the time of fitting the custom fitted orthosis to the beneficiary

Coverage and documentation requirements for knee orthoses on the following links:

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

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

Register for this national webinar today!External website


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