DME MAC officials: 'Document, document, document'

Thursday, January 14, 2010

BALTIMORE - HME providers who participated in last week's teleconference on the comprehensive error rate testing program (CERT) turned it into a venting session.

Their main beef: Why are they getting punished when a physician's documentation isn't up to snuff?

"As a provider, we don't have control over what a physician documents or doesn't document in their medical records," said Teresa Camfield of Pacific Pulmonary Services. "At the same time, the CERT is holding us accountable for lack of physician documentation."

The DME MACs hosted the "ask-the-contractor" teleconference as part of a new education initiative. Their goal: To walk providers through the CERT process, including how to respond to requests, and review frequent errors.

For the most part, however, instead of asking specific questions, HME providers expressed frustration with having to look over the shoulders of physicians.

"It seems to me that the CERT program is placing all of the responsibility on providers to train these physicians and who are we to question what the physician is putting in the patient's chart?" said George Roese of Bonro Medical.

But that's the reality, said one DME MAC official.

"You're not going to like what I'm about to say, but it truly is the responsibility of the supplier to have the information in your file and readily available to support the medical need and the criteria for the equipment you are providing," said Amy Capece, an outreach/education manager for the Jurisdiction A DME MAC. "We highly recommend that when you take on a patient, that you make sure you have that documentation."

DME MAC officials pointed out that physicians are being educated about the CERT program and that, like HME providers, they're receiving requests, too. They also reminded HME providers that they have appeals rights if they disagree with a claim that a CERT contractor has audited and denied.

One thing the DME MAC officials repeated over and over again to HME providers: "You need to document, document, document."

To view the PowerPoint presentation from the teleconference, including the product categories with the most frequent errors, go here and click on "DME CERT ACT" under Presentations.