Reporter's notebook: Crash course in charting and other calamities


For years, HME providers have been trying to teach physicians what they need to include in their chart notes, often to no avail, says Sarah Hanna, president of ECS Billing & Consulting North.

But the transition to ICD-10 may be the thing that finally gets through to them, she says.

“How a physician gets paid corresponds to a diagnosis procedure code,” she said. “Well guess what, to prove medical necessity for an ICD-10 code, which is more specific, you have to chart in a way that proves all these different characteristics of that ICD-10 code. Hello, we’ve been trying to do this for years.”

Where providers have often felt like the only ones out there educating physicians about proper documentation, now revenue cycle management companies and other groups tied into physician payments also have a vested interest, Hanna says.

“This should help us in the long run,” she said.

Discharge drama

Speaking of rude awakenings, discharge planners in hospitals are finding out real fast that they can no longer discharge patients with HME without a detailed written order signed by a physician, says Sylvia Toscano, owner of Professional Medical Administrators.

“They ask, ‘What’s changed,’” she said. “A lot of times we talk, talk, talk, but it only becomes an impact when they can’t dispense.”

Once discharge planners know the real impact of the change, which went into effect Jan. 1, there are still challenges to overcome.

“We’re hearing a lot of, ‘The physician has already done the rounds and isn’t due to come back around for awhile,” she said. “The patient can’t get the DME; it’s creating some access issues.”

Bigger ticket, bigger pain

No one’s happy about the suspension of the assignment of new appeals to the administrative law judges (ALJs), but perhaps least happy of all are complex rehab providers, says Kelly Wolfe, CEO of Regency Billing and Consulting.

“The people looking at these claims at the earlier levels don’t always know what they’re looking for, because they don’t see many custom chairs, so most providers will try to turn it around at the ALJ,” she said.

But with the suspension, that’s no longer an option, Wolfe says.

“These are big-ticket items—we have one provider who has $127,000 wrapped up,” she said. “Now there are businesses that are being forced to close their doors.”