Have You Received Your Audit Request? If you have not received an audit request from AdvanceMed already, it is likely that you will. AdvanceMed is an
by Jane Bunch

Have You Received Your Audit Request?

If you have not received an audit request from AdvanceMed
already, it is likely that you will.

AdvanceMed is an independent auditor hired to perform audits for
the Centers for Medicare and Medicaid Services. The Comprehensive
Error Rate Testing program, or CERT, allows CMS to monitor claims
to ensure that they are accurate, and therefore, should be

Let's review to make sure your documentation meets the
requirements to pass these audits — and so that your claims
will be reimbursed.

Physician Orders

Physician orders must be complete and accurate. A 3"×5"
prescription slip that reads “bedside commode, diagnosis: CVA
(cerebrovascular accident),” even if it contains the
patient's name and the doctor's signature, is not an acceptable

What does constitute a compliant physician order? Check your
orders for the following:

Patient's name, address and Health Insurance Claim (HIC)

  • Physician's name, address and UPIN

  • Quantity of the item to be dispensed

  • Frequency of use

  • ICD-9 code or narrative diagnosis

  • Specific type of equipment or supply ordered

  • Date of the order

  • Length of need

  • Physician's signature and date

  • Medical necessity of the item

    Certificates of Medical Necessity

    CMNs must comply to Medicare guidelines; providers can face
    large fines if they are not. Check your CMNs for accuracy and
    completion. As a provider, you must complete Sections A and C of
    any CMN before it is delivered to the physician's office for his or
    her signature and date.

    In Section A, make sure to include:

    Patient demographics

  • Place of service

  • Provider's information

  • Physician's information, including UPIN

  • Patient's date of birth, sex, height and weight

    Section B must be completed by the physician or an employee of
    the physician. If someone other than the physician completes
    Section B, that person's name, title and employer must be stated.
    Section B also gives the medical necessity qualifications for the
    equipment being ordered.

    Section C, to be completed by the provider, must state the
    equipment, supplies and accessories being ordered, as well as the
    Medicare allowable and supplier's charge.

    Section D includes the treating physician's signature and the
    date of the physician's signature.

    Remember to make sure the CMN retains its back section, which
    includes printed instructions for the physician on how to complete
    the CMN. Any changes made on the CMN must have the physician's
    initials and date. Any electronic CMN that is transmitted to the
    DMERC must be a mirror image of the paper CMN.

    Go through your CMNs thoroughly. If you find any that are not in
    complete compliance, obtain revised CMNs so that you will be
    prepared for auditing.

    Written Order Prior to Delivery

    For items requiring a written order prior to delivery (WOPD),
    verify that you have a signed, written order in your hands before
    the equipment is delivered or leaves your showroom floor. A WOPD is
    required for:

    Support surfaces

  • Transcutaneous electrical nerve stimulator (TENS) units

  • Seat lift mechanisms

  • Negative pressure wound therapy (NPWT)

  • Power-operated vehicles (POVs)

    Before sending any audit to AdvanceMed or directly to your
    DMERC, it may be wise to have an outside review of the
    documentation to avoid an overpayment, or a possible denial of a
    pre-payment review. The saying “pay now or pay later”
    comes true all too often for many providers.

    Jane Bunch is CEO of Kennesaw, Ga.-based JB&CS. A
    reimbursement specialist, Bunch delivers educational seminars
    worldwide, helps develop corporate compliance plans, and serves as
    a consultant for fraud and abuse cases. She can be reached at
    678/445-1221 or via e-mail at target="_blank">BILLHME@aol.com.