Reimbursement

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Saturday, August 31, 2002

Audit proofing paperwork
WITH BRUCE BROTHIS
Q. What should I do if I receive a request for 30 patient charts from Medicare?

A. CMS is undertaking larger and more in-depth audits than it has in the past and is using sub-contractors to conduct them. These audits, in the form of a rather benign letter, request all available documentation on an average of 30 patients to whom you have provided more commonly abused items such as power chairs, support surfaces and oxygen, to name a few. The result of these audits could have serious financial ramifications to your company. Not only could CMS impose overpayment policies on the requested patients, but through extrapolation, your tab for the investigation could include patients not even listed in the audit. For example, if you receive an audit for 30 K0011 patients for a given time period and you provided 90 K0011s in the same period, your potential exposure could be three times the result of the 30 patient audit. So here are a few tips to help you through this process:

- Never ignore the audit and hope it will go away. It won't.

- Always keep your patient charts audit-proof by having complete, accurate and qualifying paperwork such as assignment of benefits, ABNs, CMNs, rent/purchase option letters, prescriptions, delivery tickets and supporting medical documentation.

- Deadline extensions for the submission of the information are available with a valid supporting reason.

If your charts are a complete mess I strongly recommend you bring in an expert to assist with the defense of the audit.

Bruce Brothis is v.p. of B&B Online HME Services, Incorporated. Reach him at 800-396-9910.

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