All,
Here are the responses I received, please keep in mind that I don’t think some
of these are really allowed under the guidelines, but I wanted to post all of
the ones I received:
1. Fill out note by practitioner and have physician sign
2. At this point, I am developing medical necessity templates for the different
sections, plus a catch-all template for the other miscellaneous codes. These
will be emailed to the physician on a general email. At that point, they can
have a medical assistant cut and paste from the email to the record. They also
have the option of dictating the information or we will print out a copy on a
Word.com template for progress notes that has the physician’s name in the footer
and the patient’s name in the header or footer.
Good luck! PS: Remember that if you fax the form over and they fax it back, it
will show up as provided to the physician and will not be valid. (you know-two
fax number headers on the paper and stuff.)
3. This is why these audits are illegal, I not our job to train or educated
physician’s on K-levels, it is Medicare. I also feel that it Medicare
responsibility to pay the Dr’s for this extra work and training.
Why in hell should a physician believe us in regards to medical documentation
and Medicare, and what make us qualify to train the Dr’s on these issues? If
not US then who is the question? I look at this, they make the rules they have
to live by them.
Training does not come from a lower authority, only a higher Authority! I like
a criminal telling a judge what the law is!
They are only doing these audits to shake money out of the tree, so just start
saying that the audits are ilegal.
4. Our office basically took Medicare guidelines/Ottobock guidelines came up
with a form to assist the Physician to fill out while the patient is present
during there prosthetic E val..
5. Zita Upchurch, Senior Analysis at CGS for Jurisdication C, suggested to us
we write a complete detailed letter to the physician documenting every detail
that is necessary including the history of the patient with our office, history
of ambulation, family involvement, current K level any changes in K levels, his
current lifestyle, his goal for quality of life, summary of every visit
including detailed information on the initial evaluation and detailed
information on the delivery. I believe Zita justified this as an ‘amendment’ to
the physician documentation. Once you have the detailed letter written
include a paragraph explaining to the physician why you are sending this
detailed information for his “co-signature”, ask if there is any further
documentation the physician feels necessary to add. Send with it a copy of the
Physician documentation letter from CGS. We had about 4 docs last summer that
specifically stated “patient presented in a wheelchair”. 3 of these patients
had been amputees for over 15 years, one a bilateral that needed resockets due
to weight loss and literally couldn’t wear his limbs, beside the fact the
parking lot to the physician office was a football field distance from his 3rd
floor office. CARELESSNESS on the part of the physician. We have not been
audited on any of those files, so I dont know if this would pass. However, I
record every conversation with any insurance person – and I have a 57 minute
conversation with Ms. Upchurch where she told us to do this and how to do this.
6. Get a name of the person doing the review. Tell them that since they are
keeping the money from you, you need to keep the prosthesis/orthosis from the
patient. But make sure that they know that you are going to notify the patient
of the person making the decision by name. I mean, if there were a fall, God
forbid, they would need to know who had a share in the responsibility, right?
Also, since everything goes to ALJ anyway, notify the DMERC about that and tell
them that since you have evidence of blatant disregard of the submitted
materials, you will be only submitting the most elementary of materials from now
on and take a leisurely approach to compiling material for the person who will
actually look at it-the alj judge.
7. When I request physicians progress notes for a patient I fax documentation
downloaded from the Noridian Medicare website that specifically states what is
needed for either a prosthetic or orthotic patient. The form Documentation of
Artificial Limbs includes K levels and all other pertinent information that a
physician is supposed to have for each patient. We do receive the documentation
requested, however I still have to call each physician and explain to them (or
their nurse) that a patients K level is also required. I have spoken with
several physicians and their assistants and the majority of them have never
heard of a K level and are surprised that this is needed for every Medicare
patient. If we are required by Medicare to have this information on file and
being a business that is for prosthetic/orthotic patients, why is it that
physicians who also treat prosthetic patients who have Medicare (and refer them
to us) don’t know what requirements need to be met? It should be every
physicians/clinicians offices responsibility to be aware of this. It is a
struggle for us to receive proper documentation from a referring physician when
it seems they are in the dark about what is required by Medicare.
8. We have gone with our patients to the MD to make sure it is all explained.
We also made a fill in the blank form for the MD. But some doctors still say
either they are unqualified or that it is just too much paperwork and they won’t
do it. This is a battle and it’s only beginning.
9. We have struggled with getting accurate information as well…our marketing
drive this first quarter was to meet face to face with our top 25 referring
physicians and inform them of the changes and what needs to be documented. We
have been giving them the attached document as a guideline for them. So far
every physician that we have talked to, and explained the need for the following
information, have been very receptive and willing to help. We are in the
process of modifying this to be more applicable towards orthotics as well.
Hopefully the form is helpful to you. I got the form from Ossur’s website. If
we are still not receiving the information necessary then our next step is to
send the physician an ‘history and physical’ letter. This letter based off of
our initial evaluation and our findings. We know that Medicare will most likely
look at this as populating the physicians charts but we would rather communicate
the information to the physician and show a good faith attempt than to have
nothing at all.
10. Look to oandpsolutions.net and talk with Scott Schall. Very good best
practice solutions.
11. Our best chance to obtain all the craziness so far has been to have the
patient make an appointment with their doctor. We go to the appointment with the
patient, show the Doctor all the things that need to be documented. Some hate
it. Most agree to it. I then ask they fax us a copy of the note when they are
complete. Even then we still do not get everything we ask for!
But it is the only fighting chance I can see.
12. Unfortunately you’re kind of stuck until you get to the ALJ level. The
ALJ’s get it that we are the experts. We had 135 claims denied at the first two
levels. At this point more than half have been overturned by ALJ’s with none
upheld. The problem, of course, is that our money has been tied up for a year.
The Medicare reimbursement system has been broken for a long time and there is
no relief in sight. 20 years ago we went through the same thing. We demonstrated
that we were indeed the experts, but it took going through the ALJ appeals to
show the bureaucrats the error of their ways. Things calmed down afterward, but
now there is an entire new generation of bureaucrats….and here we go again.
Best of luck (especially if you are a small private business).
13. What I started doing is having 3 page document, with 4-5 Medicare
requirements bullet points explained, as that’s truly all there is to it. I
arrange for my pt to go see Dr Good, and tug along. Before Dr turns to the Pt, I
explain purpose of my presence, and ask them to read the letter I have. Then,
they basically use it as a cheat sheet, ask Pt the right questions, sign
detailed Rx, and do their notes. We request notes next. DONE. great marketing
also.
The ridiculous part of all of this is the amount of time spent to obtain all of
this documentation. We are a small, 11 people on staff, company. The amount of
time I am currently spending attempting to get this documentation without
success is ridiculous. I am hopeful somewhere in these responses I can come up
with some combination that will work for us.
Thanks for everyone’s responses.
Melissa
Funding Assistant
