Hello All,
We are in the process of appealing an audit for a KAFO for a polio patient we delivered two years ago. Our first appeal was denied due to the physicians records, however our notes and justification are adequate to determine this level of service. My question is as part of the denial they stated:
“Medicare’s regulatory documents require that supplier-produced records, even if signed by the referring physician, and attestation letters (e.g. letters of medical necessity) are deemed not to be part of a medical record for Medicare payment purposes. Templates and forms, including CMS Certificates of Medical Necessity, are subject to corroboration with information in the medical record.”
I thought our records were part of the medical record and used for Medicare payment purposes. I am curious if I am wrong or they are.
We were rarely audited but they are coming fast and furious now, spinal orthoses, AFOs and KAFOs going years back. We have won all appeals except this one.
Kevin C. Matthews, CO
Advanced Orthopedic Designs
12315 Judson Road #206
San Antonio, Texas 78233
210-657-8100
210-657-8105 fax
https://urldefense.proofpoint.com/v2/url?u=http-3A__www.advancedorthopedicdesigns.com&d=DwIFAw&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=N6vWUHDZYxsb7OVx7EkyeHYfS2BMbucw_Z2tCH7Uoq0&s=qU6_E93ns1UIuSLOqPYiOdCXVeahNLxyALcmCD5NP-Q&e=
