As I blogged on Sunday, August 24, 2008 you-know-what will run downhill on this one.
Here is the OIG report for your reading.
In summary the report states the following:
"We recommend that CMS:
- require the CERT contractor to review all available supplier documentation;
- establish a written policy to address the appropriate use of clinical inference;
- require the CERT contractor to review all medical records (including, but not limited to, physicians’ records) necessary to determine compliance with applicable requirements on medical necessity;
- document oral guidance that conflicts with written policies, such as guidance on the need for proof-of-delivery documentation in making medical review determinations;
- instruct its Medicare contractors to provide additional training to physicians that focuses on improving their medical record documentation to support ordered DME items; and
- require the CERT contractor to contact the beneficiaries named on high-risk claims, such as claims for power mobility devices, to help determine whether the beneficiaries received these items and the items were medically necessary."
I've highlighted in red the requirement that I believe will lead to tougher audit standards on physical therapists and physicians - already overburdened with declining reimbursements and rising costs.
