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.
CGM is one of the most-denied DME categories because Medicare coverage criteria are specific and the documentation rarely lines up. DocuGenius checks each CGM claim against the coverage rules that auditors actually cite, so the routine approvals flow through and only the genuine edge cases reach your team.
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.
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.
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.
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.
$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.
A 15-minute walkthrough on a real document — yours or ours. Pilot environment live in under a day.
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.
Related reading: The hidden cost of manual claims processing
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