Medicare Home Medical Supply – Billing Documentation Reviews

Process

For home medical suppliers on a pre-bill or post-bill basis, a St. Clair Senior Consultant checks, off-site, whether the proper Physician Order (PO) and Medical Record (MR) documentation is in place for billing “diabetic and other home supplies/services” claims to Medicare. For example on diabetic supplies, St. Clair identifies any “billing documentation compliance” deficiencies based upon the Medicare Glucose Monitor & Supply Documentation Checklist. Such possible diabetic documentation deficiencies include mismatches between the PO and the MR on testing frequency and insulin use, as well as proper signing & dating by the physician on the PO and the MR.

During such an off-site review, St. Clair drafts, for client consideration in advance of an “exit conference call” discussion, a “claim by claim” Excel spreadsheet and a narrative summary with regard to its findings and recommendations on various MR/PO documentation deficiencies relative to billing Medicare. After answering all of the client’s questions, St. Clair issues the final report.

Benefits

Such St. Clair reviews enable a medical supplier to assess the performance of its internal audit staff in identifying and correcting documentation deficiencies on claims which the Medicare “claims processing” contractor has requested for such billing audit purposes as to the appropriateness of claim payment. For example, if the supplier should fail such a periodic contractor diabetes documentation audit, the contractor could subject the supplier to such billing documentation audits on fifty (50) per cent of its Medicare diabetic claims over a 3-month or longer period.

Pricing

The St. Clair professional fee for a Medicare “PO and MR billing documentation” review is reasonably priced on a per claim basis.