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April 17, 2023

Insufficient Documentation of Lower Limb Orthoses to be Addressed in National Webinar on June 1, 2023

Data from the 2022 Comprehensive Error Rate Testing (CERT) Report shows that lower limb orthoses rank #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 lower limb orthoses, the DME CERT Outreach and Education Task Force will conduct a national webinar on June 1, 2023, at 2 pm ET/1 pm CT.

Register for the CERT Task Force Lower Limb Orthoses WebinarExternal website

The CERT contractor reviewed 676 claims for lower limb orthoses submitted from July 1, 2020, through June 30, 2021. Based on their review, the improper payment rate for lower limb orthoses claims was calculated at 57.5%, with projected improper payments of $187,849,948.

Top Root Causes for Errors:

  • Base item on the claim is denied therefore the related addition to the base, accessory, or supply fee is denied
  • Documentation to support coverage criteria is inadequate or missing
  • Description of the modifications to the orthotic at the time of fitting is inadequate or missing
  • Proof of delivery is inadequate or missing
  • Order is missing

You can review coverage and documentation requirements for lower limb orthoses on the following links:

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

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

Register for the CERT Task Force Lower Limb Orthoses WebinarExternal website.

Note: The DME CERT Outreach and Education Task Force consists of representatives from each of the DME MACs and is independent from the CMS CERT Team and CERT contractor, who are responsible for the calculation of the Medicare fee-for-service improper payment rate. The goal of the DME CERT Outreach and Education Task Force is to help reduce the overall CERT error rate by providing focused education to the supplier community.

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