By Kim Turner RN, Clinical Consultant, The van Halem Group
As a supplier of durable medical equipment and services, your goal is to provide the best care to the Medicare beneficiaries that you serve. However, have you ever thought about how the medical documentation you obtain impacts the Medicare coverage and payment of the items and services you provide? Proper documentation is the key to proper coverage and payment of the items and services billed and the medical documentation is the primary method of communication between the practitioner, supplier, and Medicare for promoting quality care of the beneficiaries you serve.
Why is it so important?
- Proper documentation ensures that the Medicare beneficiaries you service get the items and services that are reasonable and necessary.
- Proper documentation supports proper Medicare claim payment.
- Proper documentation supports favorable medical review decisions of the Medicare claims that you submit.
- Proper documentation with favorable medical review decisions reduces the costs that are associated with appeals.
What are the common errors related to medical documentation?
As reported by the comprehensive error rate testing (CERT) program, the top 5 documentation errors are as follows:
- Insufficient Documentation – this means something was incomplete or missing from the documentation that was submitted with the claim.
- Medical Necessity – medical documentation does not support Medicare coverage and payment guidelines for the item or service provided.
- Incorrect Coding- the HCPC or level of service billed to Medicare is not supported by the medical documentation.
- Other- an example, the medical documentation is not signed by the author for authentication.
- No Documentation – examples include supplier responds to CERT that there is no medical documentation available or supplier does not respond to the CERT request
What are the consequences of Improper Documentation?
- Loss of financial revenue
- Patient care errors
How to handle a CERT request for records? Here are some tips:
- Send ALL associated documentation that supports the item or service billed to Medicare – in addition to the practitioner’s chart note/clinical note(s), the documentation may also include therapist notes (PT/OT), home health notes (LPN/RN), lab studies, and imaging reports.
- Be sure to send the documentation by the deadline date provided in the CERT request.
- Review documentation before submitting to ensure that the documentation answers the questions who, what, when, why, and how.
The van Halem Group is available to help you with a CERT request. Contact us for more information.