Medicare paid $1.3B on CGM claims in 2023.
The OIG found $377M of it shouldn't have been paid. They're coming for some of it back.
DocuGenius reads every CGM prescription, F2F note, and insulin regimen doc against LCD L33822, including the April 2023 basal-insulin expansion and the April 2024 Type 2 hypoglycemia rules. We tell you which existing claims are at recoupment risk, and we keep the new ones clean.
See DocuGenius read a real document
Watch DocuGenius extract data, apply your rules, and log every decision live, on a sample document.
Three things, CGM-specific
We pull your CGM claims, check the documentation against LCD L33822, and tell you which existing claims are exposed, and which new ones to fix before submission.
Pull your CGM claims from wherever they live
Your billing platform, EMR exports, a folder of scanned charts. We read prescriber notes, F2F encounter records, hypoglycemia documentation, insulin regimen evidence, handwritten and scanned included. Nothing for your biller to retype.
Check against the actual LCD L33822
The April 2023 basal-insulin user criteria. The April 2024 Type 2 hypoglycemia documentation rule. The 2026 Master List update. Every CGM rule references the LCD line a UPIC will cite. Every rule is editable when your auditor's interpretation differs.
See which existing claims are at recoupment risk
Most CGM pilots find 8–15% of paid claims have documentation gaps that would fail a UPIC review. We flag them with the specific gap and the LCD line. Your team decides which to remediate, which to risk, which to voluntarily refund.
What teams report
$377M
OIG-flagged Medicare CGM overpayments. The recoupment wave through 2027 will come from this number.
1.5M
Medicare beneficiaries newly eligible after the April 2023 basal-insulin expansion. New claims are flowing in fast, most billers haven't updated their compliance rules.
12×
Medicare CGM payments grew from $109M (2018) to $1.3B (2023). Audit volume grows with payment volume, it always does.
What we are and aren't, for CGM-heavy DME shops
Asked at every demo. Saving us both 10 minutes.
DocuGenius
Your billing platform posts the claim. We read the documentation packet against LCD L33822 before it posts, and flag the gap before a UPIC does.
Generic DME software with a CGM checkbox
Generic billing software with a 'CGM' checkbox and no real CGM-specific rules. The CGM eligibility rules change every 12 months; the checkbox doesn't.
DocuGenius
LCD L33822 has changed in April 2023, April 2024, and again with the 2026 Master List. We update the rules; you review and approve. Your auditor's interpretation can amend any rule.
Generic DME software with a CGM checkbox
Static checklists written when CGM was Class II for Type 1 diabetics only. Out of date as soon as CMS publishes the next expansion.
DocuGenius
Every flag traces to the LCD line that fired and the document that satisfies it. Your biller and your auditor can both inspect the chain.
Generic DME software with a CGM checkbox
Confidence scores with no explanation. They fail at audit, which is the only place it matters.
DocuGenius
€500/month Starter. Pilot environment in a day. Retrospective signal on your existing book in 4 weeks.
Generic DME software with a CGM checkbox
Six-figure annual quotes. Six-month deployments. By then your CGM denial backlog is twice as bad.
Frequently asked
Get a 5-min walkthrough on your documents
Share your use case, we'll come prepared
What you'll get
- We'll walk through DocuGenius on a real document, yours or ours
- From signed contract to live in under 2 weeks
- Every decision logged and rule-traceable for audit
- Your data stays yours - we never train on it
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