Did you know that each subsequent claim for rental equipment implicitly asserts the patient is still using their equipment? Many are surprised to learn that failure to document continued use is grounds for denial and recoupment. With audit activity on the rise, now is a good time to revisit the basic documentation rules and options for suppliers unable to verify continued patient use.
Three Ways to Document Continued Use
The Standard Documentation Policy Article outlines three ways suppliers can document use:
Suppliers can mix and match the above methods on an annual basis, but some element of verification is essential to eliminating audit risk.
Substance is more important than form. None of the above permit suppliers to ignore contradictory evidence. For example, if the beneficiary verbally confirms they are using the equipment, but usage logs indicate otherwise, the supplier must weigh all available evidence in determining the appropriateness of continued billing.
Insurance Billing Must Cease if the Patient Stops Using the Equipment
Suppliers must discontinue insurance billing immediately when a patient stops using covered items at any point during an active rental. Suppliers usually arrange to pick up their equipment, but doctors may not want to stop treatment, especially in the case of ventilators and other life-sustaining equipment. The contradiction between coverage and care puts suppliers in a difficult position.
Use an Advance Beneficiary Notice (ABN) to Reconcile Non-Coverage With Physician Orders
For patients to keep equipment they are not using, proper procedure dictates suppliers should execute an ABN to hold the patient responsible for payment. The ABN must explain insurance will not pay for equipment in the home when the beneficiary is not using it.
The documentation burden ultimately rests with the equipment supplier. And while incorporating proactive documentation steps into billing protocol is critical, supplier procedure must also prepare customer-facing staff when evidence suggests discontinued use.
SOURCE LINKS
https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleid=55426
Three Ways to Document Continued Use
The Standard Documentation Policy Article outlines three ways suppliers can document use:
- Secure a medical record that references usage of the item,
- Document a request to refill/replace supplies, or
- Confirm the beneficiary is actively using the equipment.
Suppliers can mix and match the above methods on an annual basis, but some element of verification is essential to eliminating audit risk.
Substance is more important than form. None of the above permit suppliers to ignore contradictory evidence. For example, if the beneficiary verbally confirms they are using the equipment, but usage logs indicate otherwise, the supplier must weigh all available evidence in determining the appropriateness of continued billing.
Insurance Billing Must Cease if the Patient Stops Using the Equipment
Suppliers must discontinue insurance billing immediately when a patient stops using covered items at any point during an active rental. Suppliers usually arrange to pick up their equipment, but doctors may not want to stop treatment, especially in the case of ventilators and other life-sustaining equipment. The contradiction between coverage and care puts suppliers in a difficult position.
Use an Advance Beneficiary Notice (ABN) to Reconcile Non-Coverage With Physician Orders
For patients to keep equipment they are not using, proper procedure dictates suppliers should execute an ABN to hold the patient responsible for payment. The ABN must explain insurance will not pay for equipment in the home when the beneficiary is not using it.
The documentation burden ultimately rests with the equipment supplier. And while incorporating proactive documentation steps into billing protocol is critical, supplier procedure must also prepare customer-facing staff when evidence suggests discontinued use.
SOURCE LINKS
https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleid=55426
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