We want template, too

Thursday, May 24, 2012

When it comes to getting physicians to properly document for Medicare, power mobility devices aren’t the only products that create headaches for providers.

Therapies like oxygen and CPAP also require detailed documentation, which, if not properly noted in the doctor’s notes, means that providers won’t get paid.

So when CMS in March said it would develop an electronic clinical template for power mobility devices, providers in other markets took notice. 

“I think it would be useful in every market,” said Lelia Wilkerson, director of Heritage Medical in Burlington, Iowa. “We educate, educate and educate the doctors, but they are so busy taking care of the patients that whether they have it worded exactly correct for Medicare is not what they are worried about.”

The PMD template, currently under development, will use a series of prompts to guide physicians through the documentation process.

A similar template could work just as well with oxygen and CPAP, and could help address all the different variables that can crop up, said provider Becky Richens.

“If it’s a situation where the patient only qualifies during exertion, (the template could say) here are the other tests that you need,” said Richens, an oxygen case manager for Alpine Home Medical Equipment. “There’s all of those little things that they are unaware of and it affects the patient down the road because we are not able to bill for their oxygen.”

With less room for subjectivity, a template could even get providers and auditors on the same page, say providers.

“Right now, it’s open ended; how do we interpret it as opposed to the guy down the road?” said Sam Jarczynski, president of RxStat in St. Petersburg, Fla. “A template would help to address denials.”

A template could “revolutionize the industry,” says Andrea Stark, but only if it’s recognized as part of the medical record.

“In the past, forms and templates have been disregarded and they have stated that, ‘If this isn’t independently supported in the physician notes, this is invalidated,’” said Stark, a reimbursement consultant with MiraVista in Columbia, S.C. “Otherwise, it’s one more hoop to jump through and it’s not worth the paper it’s written on.”


With the idea of template-creation looming in the Medicare LCD, I can only guess that Medicare's staff of clinicians have finally realized how serious a problem it's been for suppliers to gather appropriate documents for powered mobiility.  Maybe it's because the policy has been in place since November 2006, and suppliers have consistently had a high denial rate on pre-payment audits for PMDs since then.  Maybe Medicare is finally realizing the problem lies with the physicians and their staff.  When you consider most physicians and their staff don't possess general knowledge of PMDs (they don't know the difference between a scooter and a power wheelchair), how can they be expected to know how to justify them?  Medicare states the physicians are mailed the LCDs on HME categories but it is obvious that they are not read and comprehended otherwise HME suppliers wouldn't have the documentation issues addressed here.  Creating templates may or may not help, but the real issue is lack LCD comprehension by the ordering practitioner. A template is just another document a practitioner has to read, which they often don't have time to do.