The Center for Medicare & Medicaid Services (CMS) has directed its contractors to conduct audits of claims for improper payments. Recently, claims paid in error have increased. According to Palmetto GBA, Medicare's contractor in California, California's error rate is at a high rate of 22%. The main reason for the claims paid in error is the lack of adequate documentation to support services billed.
According to Palmetto GBA,
"You control the documentation description what services your patients received, and your documentation serves as the basis for the bills sent to Medicare for the services you provided."
In order to lower the claims error rate, Palmetto GBA will be undertaking an "aggressive approach" to address this issue and will increase the level and frequency or pre-payment and post-payment medical review of claims across all provider types and services.
Some of the insufficiencies found in provider documentation are as follows:
- A provider's failure to respond to attempts to obtain medical records
- Medical documents submitted do not contain pertinent patients's facts (patient's condition, diagnosis, etc.
- Medical documentation is illegible, has no date, is improperly signed, etc.
The audits will be conducted by Palmetto GBA or one of several CMS payment review contractors:
CMS encourages providers to take a proactive approach to reviewing and improving documentation. This requires a "team" effort. MedPro can join your team and help you avoid unnecessary audits and penalties.