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| February CERT Alert: Physician Documentation for Durable Medical Equipment, Prosthetics, Orthotics, and SuppliesATTENTION PHYSICIANS ORDERING SUPPLIES! National Government Services (NGS) would like to encourage physicians to please respond to any CERT request they receive for their patients. Review of Comprehensive Error Rate Testing (CERT) data has shown that Jurisdiction B dollars denied are rapidly and steadily increasing related to the lack of documentation submission of medical records. (43% increase from 2007 to 2008) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers have only a limited amount of documentation that they can supply to the CERT contractor. In order for DMEPOS suppliers to continue to receive payment there must be information in the patient's medical record to support the medical necessity for the item ordered. This typically means copies of your office notes, pertinent test reports, and other pertinent healthcare records. Since physicians are the ones treating the beneficiaries and are responsible for maintaining records to support medical necessity of the services they provide, the CERT Documentation Contractor has started contacting physicians for the records to support the DMEPOS items ordered. The Program Integrity Manual 100-8 Ch 5.5.7 states :" 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 and for the frequency of use or replacement (if applicable). 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 (worsening or improvement), prognosis, nature and extent of functional limitations, other therapeutic interventions and results, past experience with related items, etc". We are asking for the cooperation of the physician community, that when a request from the CERT Documentation Contractor asking for medical records to support the DMEPOS items is received, that the provider please respond timely to the CERT Documentation Contractor's request. Failure to respond may result in your patient being responsible for part of the charges for the items received. Thank you for your continued help in the CERT program. |
| Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message. To unsubscribe/change profile: click here. |
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