Eli's Hospice Insider

Published on Sun Nov 21, 2010 PDF

Insufficient or incomplete documentation is a significant weakness among medicare providers, reviewers report.

Medical reviewers can retroactively deny your hospice claims for a number of reasons -- but one that you can easily remedy is lack of medical documentation.

You could get hit with medical review from a variety of sources these days: Medicare Administrative Contractors, intermediaries, Program Safeguard Contractors, Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors, and more.

If a medical reviewer from one of these contractors requests your medical documentation and you don't send it -- or you submit incomplete or illegible records -- your payments can be denied. Plus, money that your MAC or intermediary already sent to you can be recovered in cases of nonexistent or incomplete documentation.

The Centers for Medicare & Medicaid Services recently identified the issue of incomplete documentation as a "high dollar improper payment vulnerability," and the agency issued MLN Matters article SE1024 to discuss the topic and explain to providers that documentation should be a top priority.

Staff "should be catching insufficient documentation before a claim leaves the office, but in some cases, it's caught by RACs on the back end -- after a claim has already been reimbursed" says Atlanta-based consultant Jay Neal. "If you know you're missing documentation, you really shouldn't bill for the service in the first place, or you could have to reimburse that money down the road."

Bottom line: Oversight authorities are on the lookout for documentation mistakes, so carve out time now to both catch and prevent any sloppy record-keeping practices.