MDS Alert

Published on Thu Oct 02, 2003 PDF

If that's the question, here's the answer.

Talk about frustrating: You know staff provided skilled services but the medical record documentation to prove it is missing in action ... and the medical reviewer is saying, "no documentation, no payment."
 
"The FI won't accept documentation completed by the facility retroactively to validate the need for skilled care, which should be contemporaneous," says Jan Zacny, managing consultant with BKD LLP in Springfield, MO. Even so, Zacny advises facilities to appeal such denials all the way to the administrative law judge (ALJ), if the dollar amounts involved warrant it and staff clearly provided the skilled care. "The judges often reverse the claim denial based on personal testimony by therapists, nurses and DONs that the skilled care was indeed required and provided, even though it's not clearly documented in the record," Zacny reports.
 
Facilities should also consider appealing such claims to ward off allegations of fraud, suggests Donna Thiel, an attorney with Morgan Lewis & Bockius in Washington. "If you sincerely believe the care was provided, have witnesses to that effect, and perhaps can piece together supporting documentation such as therapy logs or copies of doctors' orders, an appeal might be worthwhile to show the facility submitted the claim to Medicare in good faith," she says.