Home Health & Hospice Week

Log those orders to comply with deadlines.

For home health agencies that often see denial codes related to physician orders, it's time to give your billing process a serious overhaul or risk continuing to throw money down the drain.

Physician order problems are plaguing home health agencies. But the denials stem from some of the easiest problems to avoid in the first place, claims consultant Lynda Dilts-Benson with Reingruber & Co. in St. Petersburg, FL.

Follow these expert tips to get your physician order procedures ship-shape:

1. Conduct a pre-billing audit. "The pre-billing review process is absolutely critical," stresses consultant M. Aaron Little with BKD in Springfield, MO. For effective audits, put one person in charge of checking that the plan of care and all interim orders have been signed and dated by the physician before billing the final episode claim, Little advises.

When you respond to an Additional Development Request (ADR), a medical review pre-screener checks your submitted documentation to see if the orders are signed and dated correctly before doing anything else, explains consultant Rose Kimball with Dallas-based billing company Med-Care Administrative Services. If you don't have these things right, nothing else on the claims matters, notes Kimball, who formerly worked in regional home health intermediary Palmetto GBA's medical review department.

2. Use a tickler file. To make sure you get the POC and orders back in time for billing, employ a tickler file that tracks every single POC and verbal order that goes out for signature, Dilts-Benson advises. You should be able to quickly scan the file and see whose records are still out so you can obtain them pronto.

If you keep a comprehensive log that includes the patient name, documentation sent, physician it's sent to, the date sent and the date returned, you can use the log to prove you had orders on time, Kimball counsels. She's had multiple clients who have won appeals of physician order denials by using their logs, Kimball tells Eli.

3. Follow up. If you haven't gotten the paperwork back by the time to bill the episode, follow up with the physician and request a fast-track turnaround. Dilts-Benson recommends hand-carrying the records to the doc, while Kimball advises using a same-day fax.

If you can't get the physician to return your paperwork, get your medical director involved, Dilts-Benson suggests. While the director can't sign for patients he hasn't seen, "he can make some phone calls to assist in moving the process along," she notes.

If you have a referring physician who is habitually non-compliant with paperwork deadlines, you may have to stop accepting his referrals rather than risk your reimbursement, Dilts-Benson says.

4. Check incoming paperwork. When you receive the paperwork back from the physician, have one person in charge of scanning it to make sure the doc signed and dated it correctly. A missing signature means the paperwork has to go back to the physician. But if the physician signs but neglects to date it, use a date stamp in locator 25 on the POC, Dilts-Benson instructs.

When the document is something other than the POC, you can still use a date stamp, but it must say "Received" in the stamp, Palmetto explains. The stamp also must say "Received" when you use it anywhere but the box for field 25, the RHHI instructs. Finally, the stamp must use black ink, not red or blue, Palmetto says.

For physicians who leave certain signature spots blank, use adhesive signature flags to point out where they need to sign and date, Kimball counsels.

5. Include orders with ADR materials. Be sure to include all applicable physician orders when you submit your documentation for an ADR, Palmetto instructs. If you have the orders but fail to submit them, you'll have to pursue a time- and resource-intensive appeal to recover your reimbursement.

6. Get specific on orders. Every order should include the discipline, frequency and duration of services, and treatment (type of care rendered), Palmetto says. "PRN orders must identify the number of visits and the specific reason for when the visit should be performed," the RHHI explains.