In terms of documenting Medicare claims, the type of home medical equipment that perhaps requires the most voluminous documentation process is power mobility.
The key driver for these detailed documentation requirements is, simply put, fraud, says Steve Gulick owner of Gulick’s Illiana Medical, the fourth generation to run the Danville, Ill.-based business, which began as a drug store back in 1846. Gulick explains that because of some high-price and high-profile instance of fraud related to power chair claims, Medicare, in a very broad-brushed approach, now requires much more detailed and well-documented claims in order to approve funding. This requires a very detailed paperwork process that must be carried out by HME providers, therapists and physicians.
And if the documentation is not right, the claim for a very expensive piece of HME can prompt an audit that results in a denial and negates funding for that claim. With that in mind, how can providers ensure they are properly documenting power mobility claims?
Help the physician help you. The documentation requirements haven’t gotten more complex for only providers. Physicians, too, must fill out more complex layers of paperwork. For years, doctors filled out a one-sheet check-off form for power mobility claims. At the bottom of the form was the “detailed” description of the codes, costs, etc., and any mobility evaluation from a therapist was included with the paperwork.
“Now the doctor needs to learn how to write,” Gulick jokes, noting that the forms have gone from check off boxes all the way back to longhand commentary and narrative much akin to old school chart notes. So, provide quick reference guides that outline what you need from physicians from a claim perspective. This will help paint an accurate picture of the patient’s situation and power chair need.
Then the doctor can write the order and send all the data, the chart notes from the physical exam, and copies of the clinical team’s report to the provider in a format that complies with Medicare policy and clearly makes a solid case why the patient needs the chair.
Build rapport with the physician. Having a tight relationship with physicians that is open and honest is critical to ensuring not only rock-solid documentation, but that each claim is clear heatedly assessed. This ensures physicians will see you as reliable, professional partner. Essentially, the provider is pre-qualifying the claim for the physician. “They refer a lot of power chair patients to me because they know that if I don’t think they need it, I tell them up front,” Gulick says.
Provide therapist referrals to doctors. Provide physicians with different therapist contacts so that they can reach out to skilled OTs, PTs and ATPs in order to get help defining the patient’s mobility challenges and needs. The therapist then writes up a clinical assessment that the physician signs and adds to the claim.
Have the correct face-to-face date. A key element of the clinical team’s assessment report is the face-to-face date. Power mobility claims must include evidence of the examination or clinical assessment with an order that documents the date when the patient met face-to-face with the physician or clinician in order to determine what the equipment specification should be. That date can vary, depending on the how the assessment transpired:
- The date the physician sees the patient and performs the entire physical exam and assessment of the patient’s mobility need at one time.
- The date the doctor signs concurrence with an assessment report after sending the patient for a clinical assessment.
- The date the physician sees the patient and signs concurrence with the clinician report after receiving a report that requires the physician follow up with the patient once again.
- The date a patient is discharged from skilled care after receiving and exam and clinical assessment during that care.
- The date when a physical exam and clinical assessment is completed by a clinic that includes both a clinician and a physician.
Work within the timeline. From that point, the provider has 45 days from the face-to-face date for the doctor to get the order to the provider. The provider also has 120 days from the face-to-face date to deliver the equipment. If a provider submits a prepackage review to Medicare to analyze ahead of time if the patient meets medical necessity requirements, then the provider has six months from the determination date to deliver the chair. This will be reviewed at audit, so date-stamp everything.
Advanced beneficiary notices. If you feel there is some doubt as to whether a patient truly needs the power mobility solution in question, you must inform the patient and have them sign an ABN. Otherwise, if Medicare refuses the claim, you could be on the hook for the cost of the power mobility device. The ABN documents that you have informed the patient of this concern and provides the patient the option to say whether he or she does or does not want the chair.
Points to take away:
- Because of past instances of fraud, Medicare requires detailed documentation of power mobility claims.
- Building rapport with physicians is important because their involvement in the process is essential.
- Provide doctors with resources and guidelines to help them document the patient’s need for the chair.
- Therapists provide a clinical assessment that is essential for the claim, so provide physicians with referrals to therapists.
- Keep careful track of dates and work within the claim’s timeline.
- If you have doubts about a claim, but a patient insists on the chair, protect yourself with an advanced beneficiary notice.