Gone are the days where DME claims were paid with minimal to no additional documentation required. Over the last few years, Medicare and private insurance payers have now requested extensive documentation for every submitted claim. Obtaining and filing the extra documentation is crucial for DME providers since you will need to show many of these documents during an audit.
Having processes in place that utilizes DME documentation checklists is beneficial. These processes ensure you gather the required documentation for every order. At the same time, when you have an effective filing system in place, it will help to ensure your claims are paid on time and are audit ready.
Audits and DME Documentation Checklists
The Centers for Medicare and Medicaid Services (CMS) have many different types of audits in place. The goal of their audits is to reduce fraud, abuse, and improper payments of claims. CMS provides many DME documentation checklists that include all required documentation to receive a claim payment.
Most of that information is what auditors will look for during their search. However, some CMS audits require additional documentation. Below are references to the most common CMS audits for you to review and ensure you’re collecting all the correct documentation.
- Comprehensive Error Rate Testing (CERT) Audits
- Medicare Administrative Contractors (MACs) Audits
- Recovery Audit Contractor (RAC) Audits
- Unified Program Integrity Contractors (UPIC) Audits
5 Benefits of Using DME Documentation Checklists
Whether you already have a medical necessity documentation process in place or need to implement one, here’s a reminder about the benefits these checklists provide.
#1 Helps to Prevent Oversights
Checklists are a reminder for needed codes, modifiers, characters, and additional actions since many claims are denied because of missing information.
#2 Improves Communication Among Staff
When everyone is using a checklist, it helps the staff work together more cohesively because they can effectively communicate with each other.
#3 Standardizes Your Claims Process
Certain DME item claims require specific documentation, and checklists are the reference point, especially when you’re not billing those items frequently.
#4 Minimizes Mistakes from Distractions
Although you try to minimize staff distractions, they still occur from coworkers, calls, or urgent assignments. That’s when a checklist can help staff to stay on track and not lose their place when submitting a claim.
#5 Enforces Compliance
Checklists help staff maintain compliance, ensuring they don’t overlook essential steps or details while ensuring consistency with every submitted claim.
Where to Find DME Documentation Checklists?
Depending on which jurisdiction your business is located in, it will determine which CMS checklist you should use. There are many resources available for you to download and access specific DME documentation checklists. Below are websites you can review based on your jurisdiction.
- DME Jurisdiction A & D – General Documentation Requirement Checklist from Noridian Healthcare Solutions
- DME Jurisdiction A – DMEPOS Categories Documentation Checklists from Noridian Healthcare Solutions
- DME Jurisdiction D – DMEPOS Categories Documentation Checklists from Noridian Healthcare Solutions
- DME Jurisdiction B – Documentation Requirement Checklists from CGS A Celerian Group Company
- DME Jurisdiction C – Documentation Requirement Checklists from CGS A Celerian Group Company
Learn if Working with DME Billers is Right for You
Implementing and maintaining an efficient billing system leads to a positive ripple effect throughout your company. Learn how Medbill can help you and your staff with DME billing needs while increasing your claims approval rates.
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