Documentation: Help physicians help you

Monday, July 27, 2015

There is a new paradigm in effectively managing your overall success with PMD referrals and the subsequent documentation of the patient’s medical necessity associated with those referrals. 

Physicians and other prescribing practitioners have historically struggled with CMS’s face-to-face exam criteria. Unfortunately, those struggles have sometimes resulted in physicians giving up on the idea of prescribing medically needed mobility equipment for their patients. Too often, based on CMS’s own data published quarterly regarding pre- and post-payment reviews, audits, and prior authorization affirmation requests, documentation error rates remain relatively high. Over the past 2–3 years, those quarterly statistics indicate error rates typically ranging from around 40% to as high as 99% in one regional jurisdiction. The average tends to consistently hover around 80%. Those are amazing statistics. If a prescribing practitioner is getting it wrong eight times out of 10, it becomes quite clear that there is confusion or lack of knowledge regarding the entirety of the face-to-face patient evaluation criteria that must be considered.

There are some very practical solutions to this challenging dilemma. CMS has developed electronic clinical evaluation guidelines that take the guesswork out of the process for prescribers. Physicians and suppliers can now integrate electronically for the purpose of maximizing assessment and documentation compliance.  

Numerous suppliers throughout the U.S. have incorporated electronic clinical technology as a part of their PMD and manual wheelchair documentation protocol. Those suppliers that have incorporated these new solutions report virtually 100% error free and CMS compliant documentation.  

The key question becomes, will physicians utilize these new electronic solutions, and the answer is a resounding yes.

In fact, many physicians utilizing these new documentation tools have indicated they won’t do it any other way because they now have a systematic, user-friendly process for doing something that was very difficult and challenging for them in the past.  

It is both interesting and notable that the Office of Inspector General supports and favors the utilization of electronic medical technologies as a safeguard against fraud and abuse. Suppliers incorporating electronic technology reduce their risk and liability relative to audits, improve patient care and outcomes, dramatically improve delivery turnaround times, and have confidence that they are getting the most complete and comprehensive documentation possible.  

It’s a new world in DME, and it requires a new way of thinking to achieve desired results.

Gary Cox is CEO He can be reached at or 888-697-6379.