Tips for Improved Documentation and Proper Payment

Tips for Improved Documentation and Proper Payment

Several new Medicare Learning Network (MLN) fact sheets offer tips on provider compliance for certain items that regularly appear on the Office of Inspector General Work Plan due to a high level of improperly paid claims. Here’s a quick synopsis.

Hospital Beds and Accessories

Physicians and other practitioners who write requisitions or orders for hospital beds and accessories should know that, in 2017, “the majority of improper payments for hospital beds and accessories were due to insufficient documentation.”

For proper payment, the physician must establish medical necessity for a hospital bed by documenting the patient’s condition (including severity and frequency of symptoms) and:

  • How a hospital bed will benefit the patient (e.g., promote good body alignment); or
  • Why the patient requires special attachments not fixable on an ordinary bed and which attachments are necessary.

Variable height and electric powered hospital beds may be covered under Medicare if documentation shows medical necessity.

Read the fact sheet for complete details.

Infusion Pumps and Related Drugs

In 2017, the Medicare Fee-For-Service improper payment rate for infusion pumps and related drugs was 23.1 percent, according to the Centers for Medicare & Medicaid Services (CMS). Insufficient documentation accounted for 76.7 percent of those improper payments.

To ensure proper payment for infusion pumps, make sure:

  • The patient is eligible for coverage;
  • Documentation shows the treatment is reasonable and necessary for the diagnosis, or treatment of illness or injury; and
  • All other applicable Medicare statutory and regulatory requirements were met (per NCD 280.14).

Medicare requires for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS):

  • A prescription for every separately billable item;
  • A detailed written order; and
  • Documentation showing all relevant policy requirements were met.

Read the fact sheet for complete details.

Laboratory Tests – Blood Counts

Physicians and non-physician practitioners (NPPs) who write requisitions or orders for blood count laboratory tests should be aware that, in 2017, insufficient documentation accounted for 89 percent of improper payments for blood counts. Incorrect coding accounted for 8.3 percent of the improper payments for these tests.

To prevent denials, make sure:

  • The treating physician/NPP orders the test;
  • The criteria used to establish medical necessity for the test is documented and based on patient-specific elements identified during the clinical assessment;
  • Medical necessity is shown in the patient’s medical record; and
  • Documentation received from the ordering physician/NPP is retained.

Read the fact sheet for complete details.

Revised Guidance

Also note that CMS has released revised guidance for:

Ambulatory Surgical Center CASCC

  • Diabetic Test Strips
  • Repetitive Scheduled Non-emergent Ambulance Prior Authorization Model
  • Telehealth Services Booklet
  • Medicare Enrollment for Institutional Providers Booklet
  • PECOS for Physicians and NPPs Booklet

See the MLN Connects Feb. 22 issue for links to these revised materials.

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

2 Responses to “Tips for Improved Documentation and Proper Payment”

  1. Dorothy Davis says:

    What supporting documentation is needed to bill CPT 94016? CPT 94016 is review and interpretation only by a physician or other qualified health care professional for Patient-initiated spirometric recording per 30-day period of time.

  2. Renee Dustman says:

    94016 is a non-covered service

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