Hello Practitioners,
I am reaching out to see if anyone has dealt with audits from private
Medicare take over plans such as Humana?
We recently received what I would call a “CERT” audit from Humana on an
above knee prosthesis we delivered last year. They are requesting the
similar information we are seeing in Medicare audits including; Proof of
delivery, Certificate of medically necessity, Notes, physician notes, Order,
prescriptions.
They are calling it a DME Medical Necessity review.
My question is, can they do this? We have been told in the past that these
private Medicare plans do not have the same requirements as far as what we
need have for documentation. What documentation requirements are we held
too for these private plans?
Any insight is appreciated.
Jeff Boonstra CP
