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Documentation & Claims 

Many DMEPOS Suppliers simply do not have enough medical record documentation in their patients medical records to JUSTIFY claims for payment/reimbursement.  Furthermore, I have found that many DMEPOS Suppliers simply have a "Detailed Prescription" and a few Practitioner Clinical Notes, and that is it!  

 

If you are one of these mentioned, you are in for a rude awakening if you get audited, which there are many audits going on, especially with the RAC's and Medicare.  Words to the wise...conduct a medical record audit, especially for the past five (5) years, and make sure that you have sufficient medical record documentation to back up and justify your claims.  It is also important to KNOW YOUR ACTIVE MEDICAL POLICIES as it relates to medical record documentation, and DO NOT "THINK" that you know them, as that can come back to haunt you later.   

 

I am astounded at the number of suppliers that simply overlook this critical area, and even more so that "think" they are documenting and retrieving supporting medical documentation, when in fact many are really clueless. 

 

I have to ask myself...WHY??? It is my firm belief that this happens for several reasons.  In my humble opinion, they are, but not limited to, the following:

 

1.  O&P Schools do not "clearly" teach Practitioners about the "do's and don'ts" regarding medical record documentation, and supporting documentation.

 

2.  O&P Facilities/Suppliers fail to hire "qualified" employees with medical background experience.

 

3.  Failure to review and keep current with the LCD's...Medical Policies.

 

4.  Lack of understanding of what Supporting Documentation is, and what documentation to request from referring physicians, and other healthcare providers.

 

Lastly, you should never assume that  you are in the clear if your claim(s) have been paid...there are always the "post audits" that can take place, and can go back at least five (5) years.  AUDIT, AUDIT, AUDIT...Protect your Practice and"Stay Connected"...you're business depends on it. 

 

 



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Comments

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