By Donna Youngblood, RN, BSN, CPC
The CERT program released a report for the 2018 Medicare FFS National Improper Payment Rate for DMEPOS. The data was pulled from claims submitted during the 12-month period from July 1, 2016 through June 30, 2017 and the improper rate for DMEPOS was 44% or $3.65 billion. “Insufficient documentation” made up 58% of improper rates during this time span. “Insufficient documentation” was identified as inadequate/missing provider’s order and missing/inadequate records related to face to face requirements and medical necessity.
Standard documentation requirements state that a Detailed Written Order (DWO) is required before billing a claim.
Orders for equipment and supplies must include:
- Beneficiary name;
- A description of the item to include all items,
options or additional features that are separately billed or require an
upgraded code. The description can be either a general description (e.g.,
wheelchair or hospital bed), a brand name/model number, a HCPCS code, or a
HCPCS code narrative;
- For equipment - All options or accessories that will be separately billed or that will require an upgraded code;
- For
supplies – All supplies that will be separately billed (List each separately),
and for each include:
- Frequency of use, if applicable
- Quantity to be dispensed
- Date of the order;
- Physician/practitioner signature (and signature date for a supplier generated order)
If the supply is a DME drug, the detailed written order must include:
- Beneficiary name;
- The name of the drug;
- Dosage or Concentration (if applicable);
- Frequency of administration (if applicable);
- Duration of infusion (if applicable);
- Quantity to be dispensed;
- Number of refills;
- Date of the order;
- Physician/practitioner signature;
A strong intake process on the front end is important in reviewing new orders for these required elements. You can avoid denials for insufficient documentation by being proactive from the beginning. It is invaluable for your business to take a look at your current processes and, where needed, develop new ones for this new year to prevent denials.