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May 11, 2022

Insufficient Documentation of Surgical Dressings to be Addressed in National Webinar on June 15, 2022

Data from the 2021 Comprehensive Error Rate Testing (CERT) Report shows that surgical dressings has the third highest improper payment rate among Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) items 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 June 15, 2022, at 2 pm ET/1 pm CT.

The CERT contractor reviewed 314 claims for surgical dressings on claim submission dates from July 1, 2019, through June 30, 2020. Based on their review, the improper payment rate for surgical dressings claims was calculated at 69.7%, with projected improper payments of $197,933,331.

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

Pie graph for Surgical Dressings Errors. Primarily Insufficient Doc, followed by small sections for Medical Necessity, Incorrect Coding, and Other

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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