As outlined by the Centers for Medicare and Medicaid Services (CMS), Complying with Medical Record Documentation Requirements remains critical to senior care success.
- Helps patients get reasonable and necessary items/services
- Facilitates proper claim payment
- Supports favorable medical review decisions
Specific to claims reimbursement, CMS identified the top five reasons for errors. Note, two are related to documentation.
So, what does insufficient documentation mean?
- It does NOT mean documentation doesn’t exist.
- It means something was incomplete or missing at claim submission.
And, what are the consequences of improper documentation?
- Complete forms
- Submit additional documentation
- Send a letter explaining why the claim should be paid
- Resubmit claim
Secondarily, if your order for item/service is illegible, your patient care suffers.
What are some tips for improved documentation?
- Send ALL associated documentation supporting the item/service billed
- Some information may come from a prior claim or test
- If you're not sure if certain documentation is required, send it anyway
- Send the documentation by the deadline indicated in the request
- Review documentation to make sure it:
- Answers who, what, when, why, and how
- Verifies item/service was performed
- Verifies medical necessity
Where can I get more information regarding CMS claims errors, including documentation?
- Complying with Medical Record Documentation Requirements
- Complying with Medicare Signature Requirements
Lastly, senior care and skilled nursing facilities (SNFs) can greatly simplify claims revenue management by employing a system customized for this industry, and supported by seasoned claims professionals. Get in touch if we can help.