Medicare Compliance & Reimbursement

You have most likely heard the phrase "if it wasn't documented, it wasn't done" so many times that it's old hat -- and yet, insufficient documentation remains one of the biggest denial reasons among Medicare contractors. The OIG tried to improve upon that denial rate by offering practices a second chance to turn in required documentation -- but the majority passed on the offer, leaving contractors no choice but to request a refund of the money that practices had received for those services.

Following a review of the 2010 CERT results, which featured a 10.5 percent error rate (totaling $34.3 billion), the OIG offered practices yet another chance to send in required documentation to support their services. However, only 34 percent of practices that the OIG contacted submitted additional documentation that allowed the CERT contractor to overturn its claim payment denials.

The remaining 66 percent of providers did not submit documentation that supported the medical necessity of their claims, which meant they forfeited the reimbursement they had received for those services.

Although the 34 percent that did resubmit documentation allowed the OIG to calculate a lower claims error rate than the original CERT report, the fact that less than half of practices submitted documentation to support their services should be a wake-up call.

To read the OIG report, visit http://oig.hhs.gov/oas/reports/region10/11100502.pdf.

If you can't communicate with your patient, you're unable to give him the best care possible. That's the verdict from a recent government settlement with a Maryland-based dialysis center.

The HHS Department announced on Feb. 17 that it entered into a settlement with the dialysis center following an investigation involving a deaf patient who was refused access to a sign language interpreter for his treatment. The dialysis facility attempted to communicate with the patient via writing notes, but because the patient was also vision impaired, the notes were not adequate, his family alleged.

Under the agreement, the facility must "ensure individuals who are deaf and hard of hearing have equal access to programs and activities as required," the HHS news release states. The facility must draft policies to ensure effective communication with patients, must train staff members on their non-discrimination obligations, and "provide patients notice of their right to appropriate auxiliary aids and services free of charge," the release states.

Background: State and federal laws require health care practitioners to provide accommodations to allow patients to effectively understand information about their medical treatment and decision options.

Reference: To read more about the HHS decision, visit www.hhs.gov/news/press/2012pres/02/20120217c.html.

Keep a wary eye on what Medicare's Recovery Audit Contractors are doing now, because they appear to be gearing up to focus on small providers. Medicare RACs can now request more records for complex reviews. "Under the previous formula, providers ... with a lower volume of claims would only be required to submit one or two claims per a 45 day period," says accountant Janice Potter with FR&R Healthcare Consulting Inc. in Deerfield, Ill., which covered this topic in a September client bulletin. "This would not make for a valid sample for the RACs to review. Using the new rules, the minimum number of records to be requested is 35 claims," Potter tells Eli.

Watch out: FR&R believes "the change was specifically made to enable RACs to look at SNFs and other small providers," Potter adds.