By Donna Youngblood, RN, BSN, CPC
If you are providing capped rental DME items or dispensing consumable/non-consumable supplies, there must be information in each patient’s medical record to support that the item continues to remain reasonable and necessary. Too often we see audit issues arise in instances that the original order prescribed “99” refills but beyond that there is no further documentation in the patient’s medical record. Even though you may have a valid order for dispensing, CMS wants to be sure that the item(s) continue to be needed by the patient. Documentation used to justify continued medical need must be timely for the date of service (DOS) under review. Timely documentation is defined as “an order or progress note in the preceding 12 months unless otherwise specified within an LCD or NCD.” The following may support continued medical need:
- A recent order by the treating physician/practitioner for refills; or
- A recent change in prescription; or
- A properly completed CMN or DIF with an appropriate length of need specified; or
- Timely documentation in the patient’s medical record showing usage of the item
A best practice is to initiate an internal process of obtaining an annual order or progress note documenting that the patient continues to use the DMEPOS in question. All information should be kept in the patient’s file in the event of an audit. Taking this proactive approach is especially beneficial should you receive an audit for supplies.
Want to feel confident your claims are “audit ready”? The van Halem Group offers a variety of proactive services to get you audit ready in 2019. From prescreens services to proactive claims audits, we can help! Contact us today for more information!