01/12/2024

DMEPOS Improper Payment Rate Shows Continued Improvement

Source:  American Association for Homecare Insider 1/10/24

CMS recently published their 2023 improper payment report. The DMEPOS improper payment rate continued to decline from the all-time high of 74% in 2010 to 22.5% in 2023. While this shows significant improvement, it is still the highest improper payment rate when compared to all Medicare Parts A and B. Overall CMS reported an improper payment rate of 7.38% for all segments of healthcare.   

While CERT audits are random with only 8,248 claims reviewed for DMEPOS, this is the only published improper rate and as such is often viewed by policymakers and legislators as a benchmark. 

AAHomecare reviews the report in detail each year to help educate the supplier community and the DME MACs on specific policy groups and supplier types that have higher improper payment rates.  

This year’s reports continue to show the supplier types podiatry, orthopedic surgery and multispecialty clinic or group practice to have much higher improper rates than traditional DMEPOS suppliers.  On review of the product categories with the highest improper payment rates, lower limb orthoses, surgical dressings, LSO, diabetic shoes, manual wheelchairs and pneumatic compression devices topped the list.

See CMS' 2023 Medicare Fee-for-Service Supplemental Improper Payment Data for more details.