Hope?
Carey
Description
Collection
Title:
Hope?
Creator:
Carey
Date:
1/29/2012
Text:
The segment below is directly from the Medicare Manual. Please note the bottom line that states the patient's record of medical necessity can be impacted by notes by the Orthotist. Every auditor or seminar that I have heard stated that our notes or documentation were meaningless! What is your take? Does this give us more room to question our ability to impact the medical necessity requirements of our patients? Is this a ray of sunlight that says we are more than just suppliers throwing braces on people at will?
5. Documentation in the Patient's Medical Record CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, §5.7 For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient documentation of the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). The information should include the patient’s diagnosis and other pertinent information including, but not limited to, duration of the patient’s condition, clinical course (worsening or improving), prognosis, nature and extent of functional limitations, other therapeutic interventions and results, past experience with related items, etc. If an item requires a CMN or DIF, it is recommended that a copy of the completed CMN or DIF be kept in the patient’s record; however, neither a physician’s order, nor a CMN nor a DIF nor a supplier-prepared statement nor physician attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating physician or supplier. There must be information in the patient’s medical record that supports the medical necessity for the item and substantiates the answers on the CMN (if applicable) or DIF (if applicable) or information on a supplier-prepared statement or physician attestation (if applicable).
The patient’s medical record is not limited to the physician’s office records. It may include hospital, nursing home, or home health agency records and records from other professionals including, but not limited to, nurses, physical and occupational therapists, prosthetists, and orthotists
Carey Jinright, LO, ATP, MSM
Cross & 3
5. Documentation in the Patient's Medical Record CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, §5.7 For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient documentation of the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). The information should include the patient’s diagnosis and other pertinent information including, but not limited to, duration of the patient’s condition, clinical course (worsening or improving), prognosis, nature and extent of functional limitations, other therapeutic interventions and results, past experience with related items, etc. If an item requires a CMN or DIF, it is recommended that a copy of the completed CMN or DIF be kept in the patient’s record; however, neither a physician’s order, nor a CMN nor a DIF nor a supplier-prepared statement nor physician attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating physician or supplier. There must be information in the patient’s medical record that supports the medical necessity for the item and substantiates the answers on the CMN (if applicable) or DIF (if applicable) or information on a supplier-prepared statement or physician attestation (if applicable).
The patient’s medical record is not limited to the physician’s office records. It may include hospital, nursing home, or home health agency records and records from other professionals including, but not limited to, nurses, physical and occupational therapists, prosthetists, and orthotists
Carey Jinright, LO, ATP, MSM
Cross & 3
Citation
Carey, “Hope?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/233258.
