How to survive a Medicare audit? Apart from not billing Medicare, there is no way out of experiencing an audit now or in the future. So the next best thing is to be fully prepared for an audit. Audit preparedness takes the form of current and accurate documentation. It’s not the quantity of documentation, but quality is what matters most.
Step 1 – Physician Documentation
The hurdle to overcome is related to insufficient physician documentation. The Centers for Medicare and Medicaid Services (CMS) needs to see the required physician documentation. This is difficult at times as physicians may be unaware of the required documentation needed by home care or hospice providers. It is up to you, the home care provider, to education the physician on what documentation is needed and when.
Step 2 – Use the ‘C’ Words
Use the words, ‘compliance’ and ‘cooperate’ with physicians in order to obtain the documentation needed and when you need it for each patient. In turn your agency can help physicians be audit ready as well when their documentation is under scrutiny. Cooperation and coordination are good things between home care providers and physicians.
Step 3 – Accountability of Patients
Good patient outcomes is not only the goal of healthcare providers, but patients as well. Encourage your patients to be more involved in their treatment and care. One way to do this is through education of what information is needed and why it’s needed in order to execute their plan of care. Patients want to know their care plan, who will care for them and when as well as what they need to do for claim reimbursement so that they are not liable. As a result, patients may apt to be motivated to contact their physician.
Most physicians may not be overly concerned that your claims are not being paid while awaiting documentation, they are concerned about their patient. A successful physicians practice will want their patients to be satisfied with not only their level of care, but the overall experience being treated by home healthcare providers that was referred by the physician.
Make it easy for the physician to provide to you the required documentation with a standard fax cover sheet that has a checkbox with the required documents needed.
The take away today is to know that documentation is your only defense in an audit. As you create a process to make it easier to obtain the required documents, you need to gain the cooperation from both physicians and your patients. Lastly, conduct risk assessments with your referral sources to determine which physicians are not cooperating, which need more education, and which ones seem to understand. Thereafter, you can reach out to each physician category and follow up with your efforts to be audit ready with documentation.