Eli's Hospice Insider

Published on Tue Oct 19, 2010 PDF

When responding to an audit or denial, your cover letter should act as a table of contents for the documentation that you provide, says Joy Barry, RN, M.Ed., CLNC with Weatherbee Resources and Hospice Education Network in Hyannis, Mass. The cover letter should summarize what's in the clinical record and describe the patient's overall burden of illness.

The burden of illness includes any co-morbidities or secondary conditions that are impacting the patient's prognosis, Barry says. You should also discuss factors such as advanced age, degree of frailty, location of care, and access to other healthcare providers and caregivers. These conditions can impact an individual patient's burden of illness and life expectancy. The "normal course" of a disease differs from patient to patient, Barry says.

For example: An elderly, malnourished COPD patient who lives in a rural area with limited access to other healthcare providers and caregivers may have a heavier burden of illness than an affluent, citydwelling COPD patient, Barry says.

The cover letter humanizes the patient to the auditor, Barry says. The patient is no longer "Number 1573," but becomes "Mrs. Jones."

"These patients have a rich life history that can get lost in the data," Barry says. The cover letter can put a human face on the data in the record.