OIG rips on HME documentation

Thursday, January 28, 2010

WASHINGTON - About 50% of the time, the KX modifier does not ensure that HME providers have the required supporting documentation on file, according to a new report from the Office of Inspector General (OIG).

The OIG examined 100 claims with the KX modifier from 2006 totaling $8,809. It found that providers didn't have the required documentation on file for 54 claims totaling $4,574.

"Based on our sample, we estimated that Palmetto GBA (the DMERC for Jurisdiction C at the time) paid approximately $127 million to suppliers who did not have the required documentation on file to support items with 2006 dates of service," the OIG stated.

Providers must have physician orders and proof of delivery for all HME, but they must use the KX modifier and keep supporting documentation on file for certain equipment. For example, they must have documentation that a sleep study was performed before the date of a physician's order for a respiratory assist device.

The types of missing documentation included proof of delivery (23 of 100 items); physician's order (20 of 100 items); use or compliant use follow-up documentation (19 of 72 applicable items); and physician's statement (five of 28 applicable items).

For 10 of the 54 items, providers were missing multiple required documents.

The OIG recommends that Cigna Government Services, the DME MAC for Jurisdiction C, recover payments for items for which the providers did not have the required documentation; review other payments and recover any additional unallowable payments; notify CMS of the 23 providers that did not meet the standard for maintaining proof of delivery; and develop a corrective action plan to improve the effectiveness of the KX modifier.