Lower error rates by involving patients, clinicians

Friday, February 24, 2012

YARMOUTH, Maine - With the DME MACs issuing reports of 80% to 90% error rates for power wheelchairs every quarter, it's clear some providers are having trouble with documentation. 

So what can providers do to make sure they get everything they need to be reimbursed? Here's some advice.

Spell it out

Provider Chris Henry says he sends a packet with the physical therapist's evaluation that explains, step by step, what Medicare needs the physician to document. "While this is not a Medicare document specifically, it is something that Medicare accepts as documentation during the audits that we've had, as well as our ALJ reviews," said Henry, CEO of The Medical Store in South Burlington, Vt. Henry said the packet also helps him get the information he needs in a timely manner.

Enlist a clinician

"We're finding that 95% or more of the time, even for a sit and ride, we need to have the physician refer them to a physical therapist or occupational therapist for a full evaluation to acquire enough documentation to qualify someone for a power chair," said Rex Maxey, president of Penn York Medical Supplies in Binghamton, N.Y. Clinicians who specialize in mobility can do a complete evaluation of the patient, which the doctor can sign off on. 

Involve the patient

Charles Barrett, an ATP at Germantown, Md.-based Roberts Home Medical, lets patients know upfront what Medicare requires so they can take control of the process. "It puts it back in their hands," said Barrett. He sends information to the patient outlining what Medicare is looking for, and follows that up with a similar packet for the doctor. 

Keep at it

If something is missing or incomplete, provider Scott Soderquist says the best thing a provider can do is work until all Medicare requirements are met. "All I can say is 'persistence,'" said Soderquist, president of Rehab Equipment Associates in Manchester, N.H. "If it's not right, get back with the doctor's office and explain what you need."