‘Let’s put the last piece in this puzzle’

Monday, March 31, 2008

Do we agree that when it comes to obtaining mobility assistive equipment (MAE) through Medicare, nothing is more important than the information that is documented within the patient’s medical record?
Providers have heard this message ever since the local coverage determinations (LCDs) were updated in 2002, indicating a beneficiary qualifies for coverage based on documented medical record and not the CMN/order. The record can reflect various sources: physician notes, PT or OT notes, home health notes, tests and the list goes on. It sounds simple. After all, we’re talking about physicians and other clinical staff who document diagnostic history, what type of MAE is needed and why, rate range of motion, upper and lower extremity strength, ambulation status, self-propulsion and more.
Here’s where it gets iffy. Physicians must enter MAE information in the same way that other patient information is normally charted, so they can’t use provider-designed forms. Additionally, every single professional documents the patient medical record differently. Somewhere in the physician’s notes, there must be an entry stating the patient was seen for the purpose of mobility. The clinician or physician notes must also indicate why the beneficiary cannot safely utilize a lesser level of MAE.
Providers must be able to determine if the medical record information received meets policy mandates in advance of providing a product and billing Medicare. Industry consultants have hinted, suggested, encouraged and, ultimately, directed providers to think smart and obtain the medical record information in advance of providing product. Savvy providers have determined where their greatest liability lies or instituted internal procedures to collect the needed information prior to delivery in all product lines.
The trick is training staff to know what information is required, then training them to identify the information within the medical record. How do providers make certain staff is adequately trained to recognize required MAE information? More importantly, how do we train staff to effectively communicate to referral sources what is missing without offending or agitating to the point that they order elsewhere?
I’ve just scratched the surface! Don’t forget, providers are attempting to service customers in a timely manner and maintain profitability amidst the monumental e-mails, faxes and phone calls to get the documentation right.
Since the onset of the National Coverage Decision in 2005, which removed bed/chair confinement and established the mobility related activities of daily living approach to warranting product, state associations and other groups have presented an array of programs for providers. Remember, CMS advised providers to educate referral sources. We thought we understood, but recent K0823 audits initiated by TriCenturion highlight ongoing documentation confusion.
The time has come for a national presentation to serve as a comprehensive resource for physicians, clinicians and all others who enter information into the patient’s medical record for all levels of MAE. The program needs to demonstrate a physician examination and clinical assessment, plus detail the role of the provider, and what we can and cannot do to facilitate the documentation process.
Let’s put the last piece in this puzzle! HME

Georgie Blackburn is the vice president of government relations and legislative affairs for Blackburns.