CGS Administrators, the Jurisdictions B and C DME MAC, has announced a widespread medical record pre-payment review of claims from new suppliers for Group 1 urological supplies.
“The Urological Supplies policy group continues to rank high in Comprehensive Error Rate Testing errors for Jurisdictions B and C,” CGS said in a Feb. 3 announcement. “Additionally, a February 2025 Office of Inspector General report documents improper payments for urological supplies, including intermittent urinary catheters. CGS has also observed unusually high utilization of urological supplies billed by new suppliers across DME Jurisdictions B and C.”
CGS will be reviewing medical records “for selected claims before payment” submitted by new suppliers. The process will include CGS sending additional documentation requests (ADRs) for these claims.
The ADR will ask for the treating practitioners’ written orders; relevant medical records to support the medical necessity for intermittent catheterization; other pertinent documentation; and Advance Beneficiary Notices, if the suppliers received them.
“Additionally, for sterile intermittent catheter kits, medical records must document that the beneficiary meets one of the coverage criteria listed in the urological supplies Local Coverage Determination specific to sterile intermittent catheter kits,” CGS said.
