Documentation lookup enters testing phase

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Friday, March 1, 2019

WASHINGTON – Medicare’s documentation lookup service is moving ahead into various testing phases, according to CMS and other officials on a recent Special Open Door Forum.

The Documentation Requirement Lookup Service, launched in 2018, will pull together existing requirements that are currently scattered among various manuals, National Coverage Determinations and Local Coverage Determinations, and present them in a machine-readable format within the electronic health record, according to CMS. The idea is to reduce the burden on physicians, reduce improper payments and appeals, and improve the exchange of information between provider and payer.

The DLRS is based on two “use” cases: coverage requirements discovery, and documentation templates and rules. Testing of the CRD has begun and testing of the DTR begins this month, said officials.

Under the multistep process, a physician ordering home oxygen therapy triggers a request; the request is generated and returns a template and rules for home oxygen therapy; that information is prepopulated from the patient’s clinical record in the template; the provider is queried in real-time for any missing information; and finally, the patient information is stored in the clinical record.

In response to a request from CMS, limited beneficiary cost information has also been included in the DLRS, officials said. That way, patients and clinicians can discuss affordability and, if necessary, alternative treatments.

CMS has also established two workgroups: A DRLS stakeholder workgroup to ensure key challenges and recommendations are included; and a DME e-prescribing workgroup to address special challenges. For instance, if a physician is checking the DLRS system to order DME, what does that look like, what are the challenges and what does CMS need to know going forward, said officials.