The Centers for Medicare & Medicaid Services (CMS) recently highlighted findings from an Office of Inspector General (OIG) report that identified improper Medicare payments for intermittent urinary catheters and sterile catheter kits. The report found that claims were frequently paid when documentation did not support eligibility for curved-tip catheters or sterile catheter kits, or when refill, proof of delivery, or Standard Written Order (SWO) requirements were not met.

This remains an important reminder for suppliers: documentation should clearly support the item billed before the claim is submitted. In Jurisdictions A and D, a second quarter 2026 review of 20,000 denied claims found that 99.7% of the observed denials were due to missing beneficiary medical records, with an estimated billed amount of $32,863,603. Complete and accurate documentation helps protect the Medicare Trust Fund by supporting payment only for covered, reasonable, and necessary items. It also protects beneficiaries by reducing avoidable denials, delays in access to medically necessary supplies, and potential financial responsibility when coverage requirements are not met.

To help reduce claim denials and improper payments, suppliers should review documentation requirements carefully and ensure medical records support for the billed items. Documentation must support medical necessity and eligibility criteria for catheters and catheter kits. Refill requests, proof of delivery, and supplier records must be maintained and made available upon request.

For example, when billing a Coude-tip catheter, in addition to showing permanent urinary incontinence or retention, the medical record should clearly document why a straight-tip catheter cannot be used. Documentation supporting the beneficiary's inability to catheterize with a straight-tip catheter is essential.

Strong documentation is one of the most effective ways to prevent claim denials and support Medicare coverage requirements. Documentation requirements can be found in the Standard Documentation Requirements for All Claims Submitted to DME MACs Article A55426. Review the CMS Urological Supplies compliance resources and current Local Coverage Determination (LCD) L33803 and Policy Article A52521 to ensure claims are billed correctly.