PMD claims: get the documentation you want

Monday, November 23, 2015

ATLANTA – It takes a village to file a PMD claim, which is why it’s so important for physicians, therapists and providers to be on the same page, said a panel of industry experts during a session at Medtrade in October.
But that’s easier said than done.
“I try to keep up with CMS policy, but mobility patients aren’t a huge part of my practice, so I can’t say I’m an expert in that area,” said Dr. James Smith, an internist at the University of Florida, who was part of the panel.
While the obvious solution is education, Dr. Smith acknowledges that it can be very difficult to change the behaviors of physicians.
“I would encourage you to give the (documentation) back to the patient or caregiver and say, ‘Take this to your doctor,’” he said. “When the patient starts complaining, that gets our attention.”
Panelist Kyle Cohan, rehab compliance supervisor for Gator Custom Mobility, shared some tips on how his company helps physicians get it right the first time around.
“What I have my staff do is communicate with doctors offices that it’s kind of like Schoolhouse Rock’s ‘Conjunction Junction,’” he said. “We tell them, ‘We’re looking for words or phrases and clauses.’”
Even therapists can make mistakes from time to time. For example, rather than documenting how a particular patient will benefit from an accessory, the OT or the ATP might describe what the accessory is used for in a general sense.
When that happens, panelist James Johnson, an OT/ATP with J and J United Rehabilitation, recommends explaining the potential consequences clearly and politely.
“If you came to me and said, ‘Look, you’ve taken the time to write this up and it’s wonderful, but it doesn’t seem like it’s specific enough and I have a feeling it’s going to get denied,’ I wouldn’t be so (frustrated),” he said.