How to Avoid Proof of Delivery Documentation Errors in CERT Audits

According to a recent announcement from CMS' Comprehensive Error Rate Testing (CERT) Task Force, there has been a significant increase in denials involving Proof of Delivery (POD) from the Durable Medical Equipment Medicare Administrative Contractors (DME MAC).

POD documentation shows that relevant audit materials were delivered on time, in full, and to the appropriate party. Many of the reported errors stem from missing or incomplete POD documentation.

Many of these documentation-related errors are avoidable with the right solutions in place. The technology is here—and providers should embrace it. 

The Problem

The Comprehensive Error Rate Testing (CERT) process was developed to support CMS in tracking and auditing Medicare Fee for Service claims. CERT audits review a random sample of these claims from a specific time period to search for improper payments.

Like any other audit, CERT audits require relevant documentation to verify claims and calculate improper payment rates at both the national and contractor-specific levels.. Each claim requires relevant documentation and support. However, recently, the CERT Task Force has identified a pattern of errors regarding DME MAC documentation. 

According to the CERT DME Proof of Delivery Requirements Work Guide, POD documentation must include:

• Beneficiary’s name
• Delivery address
• Quantity delivered
• Date delivered
• Description of the item delivered
• Other, varying requirements depending on the selected delivery method
  

Providers are required to retain this documentation for seven full years after the date services are provided. Without all the required paperwork, auditors reserve the right to deny the claim. 

The Solution

The problem many providers face when these errors arise is twofold. One, they likely have multiple systems in place for tracking paperwork, and two, they may send physical paperwork through the mail. 

This type of setup, while common, is prone to errors. With multiple overlapping systems and hundreds of sheets of paper to keep track of, it’s easy to let things slip through the cracks and face a denied claim (or series of denied claims). Fortunately, there are several solutions to improve the audit process and avoid errors.

First, at a minimum, providers should upload documentation securely through a digital gateway rather than physically shipping paperwork. Office Ally’s myESMD simplifies audits by providing a secure, direct, and digital connection to Medicare for rapid audit response. It also ensures that all documentation delivered to DME MACs is tracked in one centralized location. This provides visibility, accountability, and efficiency by eliminating the need to manage multiple tracking methods.

For more robust capabilities, providers should consider Audit & Denial Tracker. Audit & Denial Tracker uses digital tools, automated processes, and integrated, customizable workflows to compile audit response documentation. The platform allows teams to manage the audit process from the start, when the audit is automatically triggered, to the end, when CERT contracts deliver a verdict on the audit result. In between, providers can track the status of their audit response every step of the way.

Now that CMS has specifically identified paperwork errors in MAC DME audits, providers can expect increased scrutiny in this area in the near future. It’s a good time to reconsider the audit process and invest in the tools your team needs for success. 

Request more information about myESMD and Audit & Denial Tracker from Office Ally.