Mr. Gutierrez, Thank you for sharing this point with us. May I further ellaborate on your questions by posing one more: When Medicare comes out with new requirements, rules, etc. how are the Physicians made aware of these changes? I assume that there is someone, some governing body to which they all refer if they intend to be compliant with Medicare in order to continued receiving reimbursement for their service. Does ABC have a conduit of communication already established with this person/body? It has already been proven in my experience, as well as secondary through colleagues, that few physicians are receptive to receiving these updates through us as individual O&P practices and practitioners. Cheers, Rebecca Rogers, CPO, MSc
> Date: Thu, 30 Aug 2012 09:58:25 -0500
> From: ops.tonyg@GMAIL.COM
> Subject: [OANDP-L] Physician Note requirements for Prosthesis
> To: OANDP-L@LISTS.UFL.EDU
>
> A question for all.
>
> Please review the following excerpt then see the question at the bottom
>
> According to the Medicare Program Integrity Manual Chapter 5 – Items and
> Services having Special DME Review Considerations
>
> http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf
>
>
> Section 5.7 Documentation in the Patient’s Medical Record:
> “For any DMEPOS item to be covered by Medicare, the patient;s medical
> record must contain sufficient documentation of the patient’s medical
> condition to substantiate the necessity for the type and quantity of
> items ordered…… The information should include the patient’s
> diagnosis and other pertinent information including, but not limited to,
> duration of the patient’s condition, clinical course, prognosis, nature
> and extent of functional limitations, other therapeutic interventions,
> and results, past experience with related items etc. (Can all be found
> in Dear Physician Letter August 2011)
>
> It then goes on to say:
> There _*must*_ be information in the patient’s medical record that
> supports the medical necessity for the item and substantiates the
> answers on the CMN, DIF, or information on a supplier prepared statement
> or physician attestation. _
>
> __*My questions*__*are:*_
> 1. Does any of the information in this section of the document put the
> onus on the physician to have better quality notes?
> 2. Is there any ramification on the physician if their notes are not up
> to the par set in these statements and the Dear Physician letter?
> 3. Can the RAC/Pre-payment/etc (audits) that are performed on us as
> suppliers lead to an audit of a physician based on poor note quality for
> support of a DMEPOS related item?
>
> Please serious responses only, no complaints for the sake of complaining
> about the unjustness of the situation.
>
> Thank you,
>
> Tony Gutierrez
>
>
> —
> Tony Gutierrez
> Post-Resident Prosthetist
> Orthotic Prosthetic Specialists
>
>
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