Manage Your Documentation to Manage Your AR A

  • Slides: 28
Download presentation
Manage Your Documentation to Manage Your A/R: A Hand in Hand Approach Presented By:

Manage Your Documentation to Manage Your A/R: A Hand in Hand Approach Presented By: Miriam Lieber & Ronda Buhrmester

Please Complete Your Evaluation Everyone should have received an evaluation form upon entering the

Please Complete Your Evaluation Everyone should have received an evaluation form upon entering the session. Please complete evaluation form and turn in to room monitor as you exit the session. Or, you can complete your evaluation in the mobile app. Locate the session in the app and tap on the clipboard icon to begin the survey. Please help us keep the Medtrade Spring Education sessions the best in the industry by completing an evaluation for every session you attend! Your feedback is very valuable to us and will be used in planning future Medtrade Spring events! Connect with us on Social Media Twitter: @Medtrade. Connect Instagram: @Medtrade. Connect Facebook: facebook. com/medtrade #Medtrade. Spring 19 © Lieber Consulting LLC/VGM

Objectives 1. How to efficiently gather documentation at the time of order 2. Discuss

Objectives 1. How to efficiently gather documentation at the time of order 2. Discuss how much documentation is enough to qualify the patient today 3. Explore how to work A/R from a documentation perspective Lieber Consulting © Lieber. LLC Consulting LLC/VGM

Gathering Documentation Upon Intake © Lieber Consulting LLC/VGM 4

Gathering Documentation Upon Intake © Lieber Consulting LLC/VGM 4

Key Intake Information • Need strong, knowledgeable and resourceful intake department • Assures proper

Key Intake Information • Need strong, knowledgeable and resourceful intake department • Assures proper documentation is collected • Meets coverage requirements • Intake staff should understand the requirements (payer and company) • Encourage employees to ask questions • For Example: • When did you see your physician for the item being billed to insurance? • Use documentation checklists (flowsheets) • Use Dear Physician Letters © Lieber Consulting LLC/VGM 5

Additional Intake Information • Best contact method -- Text, email, automated or live call?

Additional Intake Information • Best contact method -- Text, email, automated or live call? • Replenishment query preferred contact method • Any concurrent Home Health visits? • Payment method - credit card on file • Credit card authorization form for supply replenishment/monthly rentals • Preferred method of contact for pre-setup training video • Log onto company website, app, email, text or in person? © Lieber Consulting LLC/VGM

Key Documentation Information Non-Negotiable Requirements = A MUST • Order to dispense • Medical

Key Documentation Information Non-Negotiable Requirements = A MUST • Order to dispense • Medical necessity (coverage criteria met) • • Rule out less expensive alternatives with objective measurements (manual muscle test, ROM, saturation, pain scale, etc. ) • • • Legible identifier (all documents) • Proof of receipt dates of required documents Face to face (chart note from ordering practitioner in the format of other entries) Detailed Written Order, CMN, DIF Home assessment • Assignment of benefits (AOB) • Supplier standards (i. e. warranty information, etc. ) • Delivery ticket (detailed) © Lieber Consulting LLC/VGM 7

Date & Time Rules (PIM) 5. 2. 6 - Date and Timing Requirements (Rev.

Date & Time Rules (PIM) 5. 2. 6 - Date and Timing Requirements (Rev. 722; Issued: 05 -26 -17; Effective: 06 -27 -17; Implementation: 06 -27 -17) For items outlined in 42 CFR 410. 38 (g): The date of the face-to-face examination shall be: • On or before the date of the written order (prescription). • No older than 6 months prior to the prescription date. • On or before the date of delivery for the item (s) prescribed. For all DMEPOS items unless otherwise specified, the following date and timing requirements apply: The date of the written order shall be on or before the date of delivery or date shipped if the shipping date is used as the date of service. © Lieber Consulting LLC/VGM 8

Intake Queries • Does the payer require a prior authorization? • If so, is

Intake Queries • Does the payer require a prior authorization? • If so, is medical documentation included? • Same/similar questions posed? • Is medical documentation included with order? • Financial queries Have you had a wheelchair before? Did you receive _______ supplies last month from someone else? © Lieber Consulting LLC/VGM

Additional Intake Queries • When did patient see doctor for item prescribed? • Ensure

Additional Intake Queries • When did patient see doctor for item prescribed? • Ensure it is within previous 6 months • Is order intake documented (dispensing order)? • Does patient belong to a managed care plan (e. g. HMO)? • Are you a contracted/preferred provider/in network? • If out of network, is patient willing to pay upfront? • If not, what is process for collecting your money? • Is ABN warranted? © Lieber Consulting LLC/VGM

Select Intake Efficiencies • Electronic intake a plus (Epic) • Referral portal • e.

Select Intake Efficiencies • Electronic intake a plus (Epic) • Referral portal • e. Fax distribution – a designated responsibility • Automate as many functions as possible • System to know insurance rules (Validation Rules) • Determine order viability prior to accepting • Know what to do if order isn’t viable • Non-assigned potential © Lieber Consulting LLC/VGM

Intake Software Solutions • Require credit card information (auto pay) • Insurance rules and

Intake Software Solutions • Require credit card information (auto pay) • Insurance rules and requirements • Prior Authorization • Prompt for chart/progress notes • New patient medical necessity documentation • Look for corroboration between diagnoses and products • Software to prevent/pre-empt excessive quantity • Doctor to complete medical necessity and electronically send to provider © Lieber Consulting LLC/VGM

Documentation Elements Dispensing Order Detailed Written Order • Beneficiary’s name • Physician’s name •

Documentation Elements Dispensing Order Detailed Written Order • Beneficiary’s name • Physician’s name • Date of the order (which should be the date the supplier is contacted by the physician) • Description of the item • Physician’s signature Beneficiary’s name Physician’s name Date of the order Detailed description of the item(s) • Physician signature and signature date • • – Quantity to be dispensed (if appl. ) – Frequency of use (if appl. ) – Number of refills (if appl. ) © Lieber Consulting LLC/VGM 13

Documentation Consideration How much documentation is enough? • Gathering documentation up front – Prior

Documentation Consideration How much documentation is enough? • Gathering documentation up front – Prior to dispensing equipment – request chart notes at order intake (measure % of orders with complete documentation prior to dispensing) • Referral source vulnerability (risk benefit analysis) • Ensure proper ABN employment – Knowledge based decision making • Accepting a viable order – Minimize documentation hassles and post pay audit risk, optimize first time payment retention © Lieber Consulting LLC/VGM 14

Documentation Dos and Don’ts • Don’t accept orders that you know are unprofitable –

Documentation Dos and Don’ts • Don’t accept orders that you know are unprofitable – Exceptions to be approved by leadership • The fewer exceptions the better • Don’t rely on capturing medical necessity information after • • the fact Don’t trust all insurance companies to follow Medicare protocol Do evaluate medical necessity justification prior to accepting order Do establish error limits and measure against them Do use automation to determine order acceptance options © Lieber Consulting LLC/VGM 15

Documentation as an A/R Matter © Lieber Consulting LLC/VGM 16

Documentation as an A/R Matter © Lieber Consulting LLC/VGM 16

Use Denials to Prevent Front End Mishaps • Common denial causes: – Fickle insurance

Use Denials to Prevent Front End Mishaps • Common denial causes: – Fickle insurance behavior – Grey policies – Failure to make determination about order viability on front end • Leadership weakness: – Lack of true accountability – Staff not working denials daily, etc. © Lieber Consulting LLC/VGM

Denial Management • Use data and reports to drill down – Who is responsible

Denial Management • Use data and reports to drill down – Who is responsible for obtaining this information? • Documentation matter typically • E. g. choosing wrong payer – Monthly reporting • Schedule time to review findings • Be consistent and diligent! © Lieber Consulting LLC/VGM

Denials • Work denials daily • Quantifiable results – Trend top denials – Use

Denials • Work denials daily • Quantifiable results – Trend top denials – Use waterfall cash report – Match A/R to personnel • Complimentary skill set – Utilize staff fluent in contracts as resource • Must stay current with payer changes – Designate personnel for this task © Lieber Consulting LLC/VGM

Documentation and A/R Avoid these Mishaps • Billing for items or services not provided

Documentation and A/R Avoid these Mishaps • Billing for items or services not provided • Billing patients for denied charges without a signed written notice (ABN) • Billing for items or services not ordered • Upcoding • Unbundling items or supplies • Continuing to bill for rental items after they are no longer medically necessary or capped © Lieber Consulting LLC/VGM 20

Protocol for Successful Reimbursement • Ensure everyone involved understands requirements and acts in best

Protocol for Successful Reimbursement • Ensure everyone involved understands requirements and acts in best interest of the company • Assign an internal staff member as final decision maker (give them authority to make these decisions without question) • Typically occurs during confirmation/QA process • Don’t allow delivery until all requirements are met • Make sure everyone understands policies, i. e. changes in O 2 setups • Be PROACTIVE © Lieber Consulting LLC/VGM 21

Outcomes – Which Path Will You Choose? © Lieber Consulting LLC/VGM 22

Outcomes – Which Path Will You Choose? © Lieber Consulting LLC/VGM 22

Outcomes – Which Path Will You Choose? • Rush delivery • Denial • Appeal

Outcomes – Which Path Will You Choose? • Rush delivery • Denial • Appeal • Dollars sitting in A/R, DSO is increasing • Reactive = Time and Money • No chance to obtain what is required (DOS/no pressure) • Write OFF $ © Lieber Consulting LLC/VGM 23

Outcomes – Which Path Will You Choose? • Deliver ONLY when the order is

Outcomes – Which Path Will You Choose? • Deliver ONLY when the order is 100% ready • Proactive (up front prior to delivery) • Opportunity to obtain what is required • Successful reimbursement (low denial rate, no A/R worry) To sustain profitability, a complete order with necessary documentation should be solidified prior to dispensing product. © Lieber Consulting LLC/VGM 24

Complete Intake + Clean Claim = Paid Timely & Keep Money © Lieber Consulting

Complete Intake + Clean Claim = Paid Timely & Keep Money © Lieber Consulting LLC/VGM 25

© Lieber Consulting LLC/VGM 26

© Lieber Consulting LLC/VGM 26

Presenters Ronda Buhrmester, CRT, CFm Director of Reimbursement VGM Group 217 -493 -5440 ronda.

Presenters Ronda Buhrmester, CRT, CFm Director of Reimbursement VGM Group 217 -493 -5440 ronda. buhrmester@vgm. com Miriam Lieber President Lieber Consulting LLC 818 -692 -1626 miriam@lieberconsulting. com

DISCLAIMER: The information contained in this handout is subject to change at any time

DISCLAIMER: The information contained in this handout is subject to change at any time as Medicare changes its policies and codes on an on-going basis. The contents of this handout are not to be construed as legal advice. Individuals are advised to check with their attorneys for legal counsel. Lieber Consulting LLC and VGM disclaims any and all liability related to or arising from reliance on information contained in this handout. © Lieber Consulting LLC/VGM 28

Documentation Documentation Documentation tells a story Quality documentationDocumentation Documentation Documentation tells a story Quality documentation
Radiopharmaceutical Production Documentation STOP Documentation Documentation is anRadiopharmaceutical Production Documentation STOP Documentation Documentation is an
ALEPH 500 Documentation 1 Documentation Documentation 14 2ALEPH 500 Documentation 1 Documentation Documentation 14 2
User Documentation Documentation Guidelines o Break the documentationUser Documentation Documentation Guidelines o Break the documentation
Radiopharmaceutical Production Documentation STOP Documentation Documentation is anRadiopharmaceutical Production Documentation STOP Documentation Documentation is an
Documentation 1 User Documentation 2 Technical Documentation 3Documentation 1 User Documentation 2 Technical Documentation 3
DOCUMENTATION What is Documentation Documentation is the meansDOCUMENTATION What is Documentation Documentation is the means
Domore Technical Training Documentation Documentation 1 Element DocumentationDomore Technical Training Documentation Documentation 1 Element Documentation
User Documentation Documentation Guidelines o Break the documentationUser Documentation Documentation Guidelines o Break the documentation
User Documentation Documentation Guidelines Break the documentation downUser Documentation Documentation Guidelines Break the documentation down
Software documentation Ashima Wadhwa Software documentation Documentation isSoftware documentation Ashima Wadhwa Software documentation Documentation is
Manage Student Progression Manage Progression Requirement Manage ProgressionManage Student Progression Manage Progression Requirement Manage Progression
Clinical Documentation Improvement CDI Why Your documentation reflectsClinical Documentation Improvement CDI Why Your documentation reflects
Manage Yourself Manage Your Time SelfManagement Time ManagementManage Yourself Manage Your Time SelfManagement Time Management
Manage Yourself Manage Your Time SelfManagement Time ManagementManage Yourself Manage Your Time SelfManagement Time Management
DOCUMENTATION ISOIEC 17025 2005 Documentation Welcome Todays OverviewDOCUMENTATION ISOIEC 17025 2005 Documentation Welcome Todays Overview
Documentation Need to have documentation in all programsDocumentation Need to have documentation in all programs
Examples of Technical Evaluation Documentation Task Evaluation DocumentationExamples of Technical Evaluation Documentation Task Evaluation Documentation
Clinical Documentation Excellence Program February 2015 Clinical DocumentationClinical Documentation Excellence Program February 2015 Clinical Documentation
Documentation requirements June 28 2012 Documentation requirements forDocumentation requirements June 28 2012 Documentation requirements for
Documentation Policy Technical Assistance Training Documentation ARs ResponsibilitiesDocumentation Policy Technical Assistance Training Documentation ARs Responsibilities
ACADEMIC DISCOURSE DOCUMENTATION BIBLIOGRAPHY AND INTEXT DOCUMENTATION DIFFERENTACADEMIC DISCOURSE DOCUMENTATION BIBLIOGRAPHY AND INTEXT DOCUMENTATION DIFFERENT
Documentation and Billing EMS Documentation Uses Legal recordDocumentation and Billing EMS Documentation Uses Legal record
Collection of Youth Posters Youth Documentation Centre DocumentationCollection of Youth Posters Youth Documentation Centre Documentation