Whitepaper

The Documentation Gap

Why CGM claim performance is decided before claims submission. A reference guide for CGM suppliers, RCM teams, and billing professionals.

67.6%
of improper payments attributed to absent documentation
CMS, 2024
5
upstream checkpoints where documentation gaps form before billing
Signal framework
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Overview

The Core Problem

Clean claim performance in CGM is not primarily a billing problem. It is a documentation problem, and the gap opens upstream, not at claims submission.

Centers for Medicare & Medicaid Services (CMS) compliance reporting is clear:

67.6%
of improper payments for glucose monitoring supplies during the 2024 reporting period were attributed to missing documentation. Not insufficient. Absent. The documentation records were unable to be created, collected, or verified before the CGM claim was filed.
CMS Glucose Monitoring Supplies Compliance Tip, February 2026

By the time a denial, write-off, or audit flag appears in your billing queue, capital exposure is already at risk. The window to address it closed before the supplies left the building.

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