oandp.com

A question for all.

Please review the following excerpt then see the question at the bottom

According to the Medicare Program Integrity Manual Chapter 5 - Items and
Services having Special DME Review Considerations

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf


Section 5.7 Documentation in the Patient's Medical Record:
"For any DMEPOS item to be covered by Medicare, the patient;s medical
record must contain sufficient documentation of the patient's medical
condition to substantiate the necessity for the type and quantity of
items ordered...... The information should include the patient's
diagnosis and other pertinent information including, but not limited to,
duration of the patient's condition, clinical course, prognosis, nature
and extent of functional limitations, other therapeutic interventions,
and results, past experience with related items etc. (Can all be found
in Dear Physician Letter August 2011)

It then goes on to say:
There _*must*_ be information in the patient's medical record that
supports the medical necessity for the item and substantiates the
answers on the CMN, DIF, or information on a supplier prepared statement
or physician attestation. _

__*My questions*__*are:*_
1. Does any of the information in this section of the document put the
onus on the physician to have better quality notes?
2. Is there any ramification on the physician if their notes are not up
to the par set in these statements and the Dear Physician letter?
3. Can the RAC/Pre-payment/etc (audits) that are performed on us as
suppliers lead to an audit of a physician based on poor note quality for
support of a DMEPOS related item?

Please serious responses only, no complaints for the sake of complaining
about the unjustness of the situation.

Thank you,

Tony Gutierrez


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Tony Gutierrez
Post-Resident Prosthetist
Orthotic Prosthetic Specialists