Home Health & Hospice Week

Hint: Don't fudge records to justify codes.

With law enforcement intensifying its efforts to sniff out durable medical equipment fraud and payors vowing to crack down on questionable claims, suppliers are understandably feeling a bit paranoid.

Protect yourself: Hunkering down in a darkened office and waiting for that dreaded knock at the door is not the most constructive response to your fears. Your time would be much better spent simply making sure your documentation is in order.

That was the message health care attorney Jeffrey Baird of Brown & Fortunato delivered recently to the annual meeting of the North Carolina Association of Medical Equipment Suppliers. In a workshop on responding successfully to audits or investigations, he reminded providers just how important good documentation is.

In fact, Baird urged DME suppliers to start thinking of themselves as part of a documentation industry. "It's important to offer good patient care," he told the gathering, "but [that care] means nothing with bad documentation."

Baird offered the following tips to help suppliers get their records in tip-top shape and stop looking over their shoulders:

1. Conduct periodic self-audits. The four big risk areas to address in self-audits are: coding and billing; reasonable and necessary services; proper documentation; and improper inducements, kickbacks and self-referrals. "The government likes to take kickback arrangements and segue into false claims," Baird warned.

Audit about five files a month in house and hire a consultant to come in once a year to look at 30 to 50 files, Baird recommended. "It's a lot better to find out now what the problems are than when a DME [regional carrier] auditor is at the front door," he observed.

2. Never create a record after the fact to justify a code. Baird had a case in which a large DME supplier was audited by the regional carrier and panicked because its documentation was sub par. Fearing recoupment, the supplier created documents after the fact, submitted them to the DMERC - and soon got a visit from the Federal Bureau of Investigation. Though Baird was able to deflect a full-blown criminal investigation, the supplier was forced to close up shop.

3. Don't hesitate to correct documentation problems. "There is nothing unethical or illegal about rehabilitating a bad file," said Baird. You just have to make your corrections properly. Fudging a record after the fact to justify a code is unacceptable, but going back into a file to clarify or add information in an upfront, aboveboard manner is advisable, he noted.

4. Write down information you're given. Too often suppliers fail to document information they get, especially from customers' family members.

Strategy: When a family member says something about a patient that supports services that were delivered, write the information down, date it and initial it. "We've found that very persuasive in handling audits," Baird reported.

5. Inform physicians about medical necessity requirements. "It's critical to educate doctors as best as we can," Baird advised. "For us to care for their patients, we need their progress notes." Consider offering an in-service luncheon or a dinner information session at your local country club, Baird suggested.

6. Let clients know they'll hear from payors. "We need to tell our customers that they will be contacted by Medicare," Baird urged. Let them know the program calls beneficiaries occasionally to ensure they're getting what the government paid for, and encourage them to answer honestly.

Avoid this disaster: Educating patients in this way can help prevent incidents such as one Baird dealt with in which a beneficiary got a call from Medicare about whether he got a wheelchair for which the program had been billed. The man lied and said he didn't because he was afraid the program would take the equipment away from him.

Editor's Note: Brown & Fortunato offers monographs on DME matters to suppliers free of charge. To request them, e-mail Baird at jbaird@bf-law.com.