Hello, my name is Megan Steidel and I am an Implementation Consultant with Anovus Health Care Solutions. I want to talk to you about how important documentation is for your practice to be successful in building claims for durable medical equipment. So learning objectives for today are, one, to be able to obtain sufficient information in the documentation that is required by Medicare to bill for DME, number two, to learn from the three most common mistakes regarding documentation that lead to claim denials, and number three, to learn the benefits of electronic versus paper records and decide which is more beneficial for your practice. Medicare, Medicaid, and other third-party payers require certain documents be on file on or before dispensing the product to the beneficiary. The importance of accurate documentation include these six requirements, standard written order, medical necessity, face-to-face encounter, advanced beneficiary notice, assignment of benefits, and proof of delivery. So what is a standard written order? It is a detailed written order that lists the specific type of brace that is being ordered, including all separately billable features. If a custom-fabricated brace is being ordered, this must clearly be indicated. This document may be prepared by the supplier, but the provider must review it, initial and date any changes, and then personally sign and date the order. Signature and date stamps are not acceptable. Medical orders alone are not sufficient for Medicare coverage. The SWO must also include the beneficiary's name or Medicare beneficiary identifier, otherwise known as MBI, the order date, general description of the item, quantity to be dispensed, treating practitioner name and NPI, and treating practitioner's signature. Who can prescribe DME? A doctor of medicine or MD, doctor of osteopathy or DO, doctor of podiatry or DPM, this is subject to limitations posed by the state, doctor of dental surgery or dental medicine, doctor of optometry, physician assistant or PA, nurse practitioner or NP, and clinical nurse specialist or CNS. The signature requirements include the method used shall be a written or electronic signature. Stamps signatures are not acceptable. Examples of acceptable electronic signatures include electronically signed by, authenticated by, approved by, completed by, finalized by, signed by, validated by, and sealed by. Who may complete the standard written order? Someone other than the treating practitioner may complete the elements of the SWO. The SWO must be signed by the treating or prescribing practitioner. Signatures must comply with CMS signature requirements. When is the SWO required? An SWO must be communicated to the supplier prior to claim submission. When is a new order needed? For all claims for purchases or initial rentals, when there is a change in prescription regarding quantity, type of equipment, or extension, on a regular basis specified in medical policy, even if no change, for a replacement item, and when there is a change in supplier. The patient's medical records must include the information required for use of specific modifiers, clinical documentation to support medical need and continued use of the item. The medical necessity of the brace must be clearly documented in the patient's medical records. The records could include your office notes, hospital records, for example, operative note or discharge summary, or the records of other healthcare professionals, including physical therapists or occupational therapists. The records must indicate the diagnosis and pertinent history, including symptoms, progression of the disease, other treatments that have been utilized as applicable, type of injury, or surgical procedure. It should describe whether the patient will be ambulatory with the brace. There must be a physical examination of the affected body part, including, as applicable, presence of deformity, swelling, tenderness, contracture, or spasticity, objective assessment of the joint laxity or stability, range of motion, etc. Simply listing the information on the order or on a form provided by the supplier is not sufficient and must be documented in the patient's medical records. For some HCPCC codes, a practitioner visit is required within six months preceding the order. The encounter is to gather information associated with the condition and the DME item ordered, must be documented in the medical records, and include subjective and objective beneficiary-specific information associated with diagnosing, treating, or managing a clinical condition for the DME item ordered. And if the encounter is performed via telehealth, the requirements for telehealth services and payment for telehealth services must be met. Effective August 12, 2024, L1833 no longer requires a written order prior to delivery and a face-to-face. HCPCC codes that require face-to-face can be found at the link below. Advanced Beneficiary Notice of Non-Coverage, also known as ABNs, allow Medicare beneficiaries to make informed decisions about items which they may have to pay out-of-pocket for. Giving routine notices for all claims or services is not an acceptable practice. Suppliers must use the approved CMS-R-131 form. Copy of the ABN should be delivered in person when possible. To transfer financial responsibility to a Medicare beneficiary, ABNs are mandatory for the following when Medicare does not usually pay for this many treatments or services, usually does not pay for this type of service, does not pay for this because it is a treatment that has yet to be proved effective, or does not pay for this many services within a period of time. In order to bill the claim, the patient must sign and date the assignment of benefits. Assignment of benefits is a written agreement between beneficiaries, their physicians, or other suppliers and Medicare. The beneficiary agrees to let the physician-slash-supplier request direct payment from Medicare for covered Part B services, equipment, and supplies by assigning the claim to the physician-slash-supplier. The physician-slash-supplier, in return, agrees to accept the Medicare-allowed payment amount by the Medicare Administrative Contractors as his or her full charge for the items or services. For proof of delivery, the patient must sign and date the appropriate form indicating proof of delivery by any of these methods. Method 1, delivery directly to the beneficiary or authorized representative. Method 2, delivery via shipping or delivery service. Method 3, items are delivered to a nursing facility on behalf of the beneficiary. Regardless of the method of delivery, the contractor must be able to determine that the items delivered are the same items submitted for Medicare reimbursement and that a specific beneficiary received the items. If the patient is unable to sign, his or her authorized representative – for example, spouse, family member, neighbor, or individual should have no relevant conflict of interest with the beneficiary – must sign, date, and indicate his-slash-her relationship to the patient. For products shipped directly to the patient, the shipping confirmation and invoice are required. The proof of delivery must include the beneficiary's name, delivery address, the quantity delivered, a description of the item being delivered – the description can be either a narrative description, a HCPCS code, the long description of a HCPCS code, or a brand name-slash-model number, the date delivered, and the beneficiary or designee signature. Now stop before you submit those claims. In most cases, DME claims are denied due to wrong patient information. It is important to verify that you have the correct patient information before the claim is submitted. Not including clinical documentation to support medical need and continued use of the item will result in denials. Insufficient or incomplete documentation of any of the previously mentioned requirements will also result in denials. Benefits of Electronic versus Paper Security. Electronic document management software offers robust protection by securing sensitive information and protecting businesses from data breaches. Advanced security features such as encryption and user access controls safeguard your documents from unauthorized access. Off-site backup and cloud storage options also ensure that your files are protected against unforeseen disasters at your premises. Efficiencies. An electronic documentation management software, EDMS, enhances efficiency by eliminating physical clutter and improving document accessibility. This streamlined approach to document management allows businesses to access the information they need quickly and reliably, improving overall productivity. Digitizing documents also reduces the risk of misplacing or losing important files, ensuring that your business operates smoothly. Cost. Electronic document management software is cost-effective, reducing manual document management tasks and reallocating staff to more strategic tasks. Digital storage accommodates fast-growing businesses without the expense of physical storage spaces, saving money on rent, maintenance, and security. In addition, an EDMS can help reduce printing and paper costs, contributing to significant long-term savings. Compliance. Electronic document management systems improve compliance by helping businesses adhere to document and data storage requirements. Automated record management allows for secure and timely destruction of unnecessary files, ensuring compliance with minimal effort. An EDMS can also track document revisions and maintain audit trails, making it easier to demonstrate compliance during audits or inspections. Scalability and flexibility. As your business grows, so do your document management needs. An EDMS can easily adapt to your change in requirements, allowing you to scale your document storage and organization effectively. With an electronic document management system, you can effortlessly add new users, manage permissions, and handle increased volume of documents without compromising efficiency or security. Improved collaboration and communication. An EDMS can significantly enhance collaboration and communication among team members, departments, or even remote employees. With an electronic document management system, users can access documents simultaneously, share feedback, and make real-time updates. This reduces the risk of miscommunication, streamlines project workflows, and fosters better teamwork with your organization. Environment sustainability. By transferring to a paperless office with an electronic document management software, your business can reduce its carbon footprint and support environmental sustainability. Using an EDMS minimizes paper consumption, cuts down on energy usage associated with physical document storage and transportation, and decreases waste production. By embracing digital document management, your business can demonstrate its commitment to sustainability and appeal to environmentally conscious customers and partners. Investing in an electronic document management system is a crucial asset for any business, regardless of size. Implementing an EDMS streamlines your operations, supports compliance, saves costs, and protects your valuable data. In summary, include what is necessary in documentation to get claim paid, avoid the common mistakes, and weigh your options between electronic and paper.

DME claims

documentation practices

electronic records

Medicare requirements

document management systems