Per CMS, for the 2020 reporting period, the improper payment rate for surgical dressings was 67.3% representing $194.9 million. CMS indicated 82.4% of improper payments were due to insufficient documentation. Additional errors were no documentation (1.9%), medical necessity (1.7%), incorrect coding (1.9%) and other (12.2%). Pharmacies need to ensure that the clinical information in the patient’s records proves the dressings are reasonable and necessary as well as what type and quantity of dressing(s) they qualified for. Use the helpful tips and links below to be prepared in case of an audit on surgical dressings.
- Update: Medicare Part D Mandatory E-Prescribing Requirements for Controlled Substances – Final Rule - January 11, 2023
- DMEPOS Mini-Series #8 – The Six Medicare Auditing Entities and Their Purpose - December 20, 2022
- Be on the Lookout for OptumRx Unannounced Onsite Audits - December 18, 2022