'Jump through every hoop' because prepay reviews may be inevitable

Wednesday, September 21, 2011

WASHINGTON - With a proposal to put all power wheelchairs on prepayment review making the rounds in Washington, D.C., NRRTS on Oct. 19 will host a webcast with Denise Fletcher, a health law attorney at Brown & Fortunato in Amarillo, Texas. The proposed requirement is a real threat, but Fletcher says mobility providers can be put on prepay reviews right now for not doing well on an audit or for no apparent reason.

How it happens

Providers could go to their mailboxes one morning and find it full of additional documentation requests (ADRs) with a 30-day deadline to respond, Fletcher said.

"If you don't have medical records in your chart, it's going to take you all of 30 days and sometimes even longer to gather documentation from the physician's office," she said.

What to do

"When a provider gets on prepay review I think one of the most important things that they can do is jump though every single hoop to get the documentation that they need," said Fletcher. She recommends sending a summary with the documentation that points out where each detail is in the progress notes.

What's next?

Auditors are busy, Fletcher said, and usually take around 60 days to get to a provider's audit. That could leave a provider without Medicare cash flow for more than 90 days. 

"You still need to continue to submit claims," said Fletcher. "But what I would do is, if you're on a prepay review, don't drop that claim unless it has everything in there to support it 100% because that ADR is coming."

Documentation is key

Fletcher recommends providers don't supply a product without having all of the documentation they need. 

"I know a lot of providers are against doing that because it delays delivering a product, but if you get hit with an audit, you'll be able to turn that around quickly," she said. 

Also very important: Everything needs to be backed up in the progress notes. Fletcher recommends sending Medicare documents (LCDs, FAQs, etc.) with highlighted portions showing what the provider needs from the doctor.

"Say, 'If you feel the patient meets those criteria, would you please provide an addendum and let us know, and we'd be happy to provide the equipment,'" said Fletcher. "And if the doctor doesn't feel that that is the case, then I wouldn't put the equipment out."