News

Tip From The Trenches

Date Published: June 27 2013

Does CMS prohibit the medical professional’s use of templates for DME supporting documentation?

No. The Centers for Medicaid and Medicare Services (CMS) provided recent clarification that the use of templates to facilitate record keeping is allowed. (See HME News article link at the bottom of this tip). 

CMS states that a physician/LCMP (Licensed/Certified Medical Professional) may choose any template to assist in documenting medical information. CMS further states that if a physician/LCMP chooses to use a template during the patient visit, then CMS encourages them to select one that allows for a full and complete collection of information (emphasis added by CMS) to demonstrate that the applicable coverage and coding criteria are met.  See Pub 100-08 Medicare Program Integrity, Transmittal 455, Change Request 8033, March 15, 2013. A link to a PDF of this document is included at the bottom of this tip.

Some DME providers have been wary about presenting or suggesting the use of a template to physicians to better enable the physician to gather and organize the information required for Medicare to support the need for specific medical equipment, including a power mobility device(s). Being cautious is understandable since many templates in the past have not held up under the scrutiny of Medicare, due to their insufficient ability to demonstrate that coverage and coding requirements are met as well as the medical necessity criteria for the item/service.

DMEevalumate is well aware of the concerns CMS has proffered with respect to other templates, including those types which are considered “limited space templates” which provide only limited options and/or space for the collection of information. DMEevalumate is not merely a “check box” template with “predefined answers” which CMS discourages using. The robust, state-of-the-art electronic software used by DMEevalumate allows the physician access to a comprehensive evaluative template which provides for a full and complete collection of information to demonstrate that the applicable coverage and coding criteria are met. In addition to streamlining and organizing all of the necessary HME/PMD medical documentation, DMEevalumate prompts the physician when more information or additional tests are required to further validate the specific need for HME/PMD. Further clinical documentation may be required and DME providers work with physicians to ensure all required paperwork is obtained. If a patient qualifies for a HME/PMD, the program produces a seven-element order and a face-to-face evaluation pdf, that the physician can save in the their electronic medical records, print and submit for prior authorization. 

DMEevalumate's template has helped move hundreds of HME/PMD claims through prior authorization and currently claims a 99 percent success rate.

For information about Medicare's endorsement of templates for documentation, read Elizabeth Deprey’s article published Monday, May 27, in HME News: 

http://hmenews.com/article/medicare-tweaks-documentation-process.  

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R455PI.pdf

This information is brought to you by DMEevalumate.com Tips from the Trenches, in response to FAQs from our customers. For more information, contact us at info@DMEevalumate.com 

 

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