Scooter store repairs on clients who still have a chair that is not capped out

Peggy’s updates and comments.

Scooter store repairs on clients who still have a chair that is not capped out.

    This company was instructed to send beneficiaries letters informing them that the title to their chairs have been turned over to them and it is now patient owned. The letter should include the name/make and model of the base with serial number.

If you want to try to get these claims into a paid status you can do the repairs and in the narrative state that this patient has a letter (make sure you have a copy) from the company which indicates that have transferred the title to the patient.Once this has been documented the DME Mac can convert the “CMN” to a paid status and repairs can then be covered. CAUTION: there has been no formal education on this from the DME MACs but there should be education coming out soon. The PWK work sheet can be used to allow you to actually fax the letter in with the claim. (See attached PWK form from jurisdiction B)

Technical denial tips.Be aware of the types of denials you are receiving and be pro-active to prevent them from reoccurring.

1.       DATES:  check dates for all documentation –Make sure they are not out of order.

a.   (F2F date must be prior to your company completing the in home evaluation)

 b. (The DPD must be AFTER the date of the 7 element order)

 c. (The “completion of” the face to face is the date the physician reviews and signs off on the LCMP evaluation if this evaluation is done after the actual office visit)

  d. (The DPD must be completed and signed PRIOR to your delivery)

****** CHECK  THESE BEFORE PUTTING OUT ANY EQUIPMENT*****

 

2.       SIGNATURES:   

A.      All signatures must be legible if not have the physician print their name below or do a signature log of all referral physicians/ or do an attestation statement **DO THIS BEFORE YOU BILL THE FIRST TIME***

B.      All signatures must be dated. If this is not done get it corrected up front don’t wait till you are audited.

C.      Signature on the delivery ticket must the patient’s BUT if not who ever signs needs to state their relationship to the patient and why the patient is unable to sign.

3.          Medical Necessity documentation: Power Mobility —  CHECK this for :

A.        Physicians notes and therapy notes do not conflict: ie – physician says patient walked from waiting room to office with a straight cane and no assistance but therapist states patient needed sba (standby assist) to walk ___ feet with a straight cane —-

B.      Make sure the physician actually does a basic mobility evaluation and does not just review and sign off on the therapy evaluation – a therapy evaluation does not negate the requirement for a physician to complete a F2F evaluation with discussion of mobility deficits.

C.      Height and weight must be in the medical records.

D.      Patient cognition must be addressed. The patient must have the ability to operate the mobility device safely and have willingness to use.

E.       MUST rule out an optimally configured manual wheelchair.

.    4.EDUCATION: all staff need to be educated on documentation needs including the marketing staff and there should be repeated training monthly and all updates shared with all staff.