Our firm has recently seen an increase in the number of occupational therapists (OTs), speech therapists (STs), podiatrists, psychologists, optometrists and other licensed health professionals being scrutinized in Medicare audits and recovery actions. Often these result from claims submitted for evaluation or treatment entered in nursing homes or assisted living facilities (ALFs).
You Must Provide Complete and Detailed Documentation of Care Rendered.
In many cases, the provider may not have complete documentation of the care rendered because it has been placed in the patient’s record at the facility. Unfortunately, Medicare does not see this as an excuse to provide copies of all relevant medical records in support of claims during an audit. The provider must still obtain the records and forward them to the auditor. Failure to do so will result in a complete disallowance of claims for treatment or services.
Other Problems with Fort Comings in Documentations.
Other problems we have seen with forth comings in documentation that has resulted in claims denial include:
1. Failing to have a physician’s order, prescription or referral specifically requesting the services indicated,
2. Failing to have a legible signature from a doctor ordering such services, or the physician’s typed/printed name with the letters “M.D.” or “D.O.” after the name,
3. Lack of proof of medical necessity for the services rendered,
4. Illegible medical records or illegible medical records entries,
5. Failure to have a start time and stop time for services that are billed based on the amount of time spent with the patient,
6. Failure to have the signature (electronic or manual) of the individual health professional delivering the services on the health records documenting the delivery of those services.
Such deficiencies are easy for health professionals to avoid at the time of the delivery of services. Some of these may be corrected before the documents are produced in response to an audit request. However, after the documents have been provided as a response to an audit request, it may be too late to do anything about these document deficiencies.
Obtain Representation Early.
A health law attorney experienced in Medicare and Medicaid audits can save a provider tens of thousands of dollars in claims and overpayments being reimbursed to payers. Obtain representation at the earliest possible time.
Check Your Professional Liability Insurance Policy.
Many professional liability insurance policies will pay for the cost of legal representation in a Medicare or Medicaid audit. If your insurance company does not offer this benefit, you may purchase separate insurance coverage which does provide this benefit for only a small premium. Ask your insurance agent for information on this type of coverage. After you need it, it will be too late to purchase it. This mistake could put you out of business and negatively affect your professional license.
Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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