Medicare documentation requirements

Medicare documentation requirements

David Hansford

2/4/2013

I have been reading the latest results of the Region B assessment of the
physicians documentation requirements.

I have a solution for the situation concerning acceptable documentation.

We need to set a prior authorization standard with all Medicare
intermediaries that allow us to submit our documentation for review and
acceptability before we provide the services.

It is absolutely ridiculous for CMS to require me to purchase products and
provide services before they determine that all the documentation is
accepted. I have no control over whether the physicians staff or the
physician will enter the required documentation in their patient records.

For instance I had a recent situation where the physician dictated the
appropriate documentation but later found out it never got entered into the
patients record or file. The physician then had to dictate a
delayed/corrected note. I am waiting to hear if Medicare will accept the
delayed note.

Then Medicare will forbid me from recovering my cash laid out in advanced
for this patient. To me this is government assisted shoplifting.

You don't make any other type of purchase or transaction that requires you
to lay your cash on the table and let the purchaser use your money or
product only to find out that the federal government decides you didn't meet
some technical requirement and the purchaser gets to keep your cash.

I always submit my documentation to private insurance for approval prior to
providing the services.

Maybe I am wrong in my assessment of Medicare policy that requires us to
provide the services then wait for approval and payment without the option
to recoup our costs from the patient if the documentation is rejected.
Someone please correct me if I am wrong in this assumption.

Let me hear your from our national groups about the possibility of a prior
authorization process with Medicare.

David Hansford, CPO, FAAOP