Proof of Service

To ensure providers across the HME sector are able to recoup the fees for services rendered to Medicare beneficiaries, it takes collaboration among every health care professional in the continuum of care and attention to the small details. But receiving accurate payment is only a fraction of the issue. Proof of services rendered is equally important. This is true for items ranging from diabetic testing supplies to rehabilitation and assistive technology and oxygen therapy.

From the physician who initially diagnoses the beneficiary to the providers and therapists who each have a hand in treatment, all must communicate and be educated on the steps necessary to ensure the best quality of care. This coordination includes documentation, an essential piece in allowing professionals to be recognized by the Centers for Medicare and Medicaid Services for rendered services.

Paperwork required by Medicare is a significant problem for home care providers. In the case of glucose testing supplies, members of AAHomecare’s report there is a serious and constant concern regarding the lack of suitable physician documentation. In early February, the Council sent a letter to the four DME MAC medical directors asking for a “Dear Physician” letter regarding the Medicare coverage criteria for glucose testing supplies and recommended documentation for the medical records of beneficiaries.

According to the letter, “the lack of suitable physician documentation directly harms access to critical diabetes management and prescribed supplies … We believe that a ‘Dear Physician’ letter from all DME MAC medical directors addressed to clinicians caring for Medicare patients would provide immense assistance in our ongoing educational efforts regarding the Medicare coverage of diabetes testing supplies as well as setting standards for documentation of diabetes management and testing frequency.”

Karen Kaczmarek, chair of the Medical Supplies Council, says that “while the CMS coverage criteria is generally very clear, there is an ongoing concern that physicians are not sufficiently documenting their efforts in providing ongoing management of the patient’s diabetes plan of care, when seeing patients at an office visit. This creates issues for providers who think they are obtaining all the documentation needed to be paid for the supplies ordered by the physician only to find out in an audit that the medical records provided by the physician or patient do not meet CMS standards and therefore are not eligible for payment.”

Dr. Robert Hoover, senior medical director for Cigna Government Services, the DME MAC for Jurisdiction C, is in contact with AAHomecare on the diabetes testing supplies issue and agrees that education for health care professionals in this arena is required.

Kaczmarek adds, “As providers continue to cope with increasing documentation requirements and decreasing reimbursement, it is urgent that educational tools are available to assist with obtaining the appropriate medical records for beneficiaries that they service.”

For providers of complex rehabilitation, documentation must evolve into something that includes every touch with the patient. Currently the Medicare coding system bundles equipment and service costs together. “Lack of medical record and documentation voids continue to result in significant pay-backs to Medicare,” says Georgie Blackburn, vice president of government relations for Blackburn’s in Tarentum, Pa. “With ongoing audits from various sources, it’s imperative all providers fully comprehend the nuances of the power mobility device policy.”

The AAHomecare Rehab and Assistive Technology Council has been looking closely into the documentation issue. Blackburn notes, “Complex rehab providers appear to have fared better in audit situations due to the significant documentation that has always been required and the attention to detail necessary when providing high-end power rehab products.” But she adds that ongoing education is key.

Ideally, greater respect for HME will be one by-product of changing the documentation process and working more closely to educate health care professionals about home care services.

Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at [email protected]. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org.