Quarterly Report on Audits, Region B
Jim DeWees
Description
Collection
Title:
Quarterly Report on Audits, Region B
Creator:
Jim DeWees
Date:
3/3/2015
Text:
Hello Everyone,
I just got this email today from Region B, National Government Services, Inc (the Anthem company who is contracted as the administrator for Region B), with the results of the Audit Findings.
The good news is that the error rate is dropping, BUT still a bad number, in my opinion, with over 56% of audits being DENIED! How can more than 1/2 of our claims be missing documentation, or lacking supporting documentation to support medical necessity? We must improve, and get this number down to single digits.
I am copying this here, so that everyone can see the results here in Region B. We must find a way to get this denial rate lower. We need to find ways to educate EVERYONE in this field on proper charting, and to know WHAT documentation does Medicare require to establish Medical Necessity. If we all knew what was required, and we all made sure to have this documentation in the patient file BEFORE we provide any service, we can get this denial rate down to zero.
As long at this denial rate is this high, they are only going to do MORE audits to “catch” these errors (I will not call it “fraud” because I do not think this is fraud, be definition....but I think this is more about careless documentation in most cases, or basically having no clear definition or rules about what is REALLY considered necessary or what is considered acceptable, or credible, for Medicare to use and consider as legitimate or valid documentation of functional levels or medical necessity).
Let’s figure out a way to get everyone up to speed on what Medicare requires, and HOW to pass these audits.
Personally, my facility is passing 100% of these audits. They still continue to audit 100% of my claims, but I am getting paid for all of my claims.....but it is still 3-4 months after the services are provided when I get paid. That does put a serious strain on cash-flow and keeping accounts paid.
Thank you,
Jim DeWees, CP
<URL Redacted>
I just got this email today from Region B, National Government Services, Inc (the Anthem company who is contracted as the administrator for Region B), with the results of the Audit Findings.
The good news is that the error rate is dropping, BUT still a bad number, in my opinion, with over 56% of audits being DENIED! How can more than 1/2 of our claims be missing documentation, or lacking supporting documentation to support medical necessity? We must improve, and get this number down to single digits.
I am copying this here, so that everyone can see the results here in Region B. We must find a way to get this denial rate lower. We need to find ways to educate EVERYONE in this field on proper charting, and to know WHAT documentation does Medicare require to establish Medical Necessity. If we all knew what was required, and we all made sure to have this documentation in the patient file BEFORE we provide any service, we can get this denial rate down to zero.
As long at this denial rate is this high, they are only going to do MORE audits to “catch” these errors (I will not call it “fraud” because I do not think this is fraud, be definition....but I think this is more about careless documentation in most cases, or basically having no clear definition or rules about what is REALLY considered necessary or what is considered acceptable, or credible, for Medicare to use and consider as legitimate or valid documentation of functional levels or medical necessity).
Let’s figure out a way to get everyone up to speed on what Medicare requires, and HOW to pass these audits.
Personally, my facility is passing 100% of these audits. They still continue to audit 100% of my claims, but I am getting paid for all of my claims.....but it is still 3-4 months after the services are provided when I get paid. That does put a serious strain on cash-flow and keeping accounts paid.
Thank you,
Jim DeWees, CP
<URL Redacted>
Citation
Jim DeWees, “Quarterly Report on Audits, Region B,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/237313.
