Hughes explains documentation requirements

Wednesday, November 30, 2005

ATLANTA - Many HME providers have deluded themselves into thinking that a single piece of paper can prove medical necessity and thwart a Medicare audit, according to Region A Medical Director Dr. Paul Hughes.
"As an industry, the focus on asking us what piece of paper to get leads you down the wrong path," Hughes told members of the Region A council in October at Medtrade. "There isn't a piece of paper to get."
Instead, providers need to consider what "information" they need to prove medical necessity for a particular product. That information could be hospital notes, a PT's evaluation, etc. In other words, documents that are not limited to the doctor's progress notes, Hughes said. "The rule in Medicare is that if it wasn't written down, it didn't happen," Hughes said. "What needs to be written down? Everything. Enough so that a third party who doesn't know the patient can understand the rationale for the prescription."
When a provider files a claim, the information required to accompany it is limited, but the provider should have on file all the information necessary to document medical necessity, Hughes said.