Note from the Associate Editorial Director: MACs say nab physician documentation

by Melissa Varnavas

Sound familiar? Providers of home medical equipment (HME) often express frustration with physicians in the ongoing battle to obtain proper documentation for Medicare claims.

Cajoling, begging and even educating doctors has its limitations, callers complained during a January Comprehensive Error Rate Testing (CERT) teleconference, HomeCare magazine reports.

No matter. Responsibility for proper documentation rests with the provider, not the physician, said CERT representatives from four Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC).

In response, one CERT official essentially said that if the physician gives you a hard time about providing proper documentation, just tell them that Medicare says they have to provide it.

I’ll  give those of you clinical documentation improvement specialists working in inpatient hospital settings a moment to regain your composure. You know how well this “do it because Medicare says so” tact works.

The speaker went on to elucidate the fact that the patient’s medical record must contain the following:

• sufficient documentation of the patient’s medical condition
• the patient’s diagnosis
• duration of the patient’s condition
• clinical course
• prognosis
• nature and extent of functional limitation
• therapeutic interventions
• past experience

While the conference call targeted medical equipment suppliers, I bring it to your attention to illustrate the larger CDI picture. Concerns about proper physician documentation are not limited to the inpatient setting. CMS’ contractors throughout the healthcare system are focusing on proper documentation to support appropriate medical claims.

In short, reported HomeCare magazine, “Doctors do need to document, document, document.” It is this message, CDI professionals communicate so well to their facility physicians. Programs-be they inpatient acute care facilities or durable medical equipment retailers-with CDI staff in place will no doubt do better under the onslaught of increasing scrutiny of the healthcare economy.

Editor's note: Varnvas is the associate editorial director of ACDIS. Contact her at mvarnavas@acdis.org.