If a provider receives several random audit letters from the Health Care Financing Administration requesting additional documentation, what should the provider send?

PROVIDERS IN ALL FOUR durable medical equipment regional carrier regions are receiving these audit letters. Be very thorough and careful in preparing your package to send to the specified investigative specialist at the DMERC Fraud Investigative Unit. These letters specify when the audit is due. Be on time! If you are not, call the telephone number listed and speak with the specialist regarding your problems in meeting the deadline. The majority of the letters request the following:

a) Signed, completed delivery tickets (verify they meet Medicare guidelines)

b) Signed pickup tickets

c) Completed assignment of benefits

d) Billing statements (coinsurance billings)

e) Certificates of medical necessity

f) Physician orders

g) Correspondence to or from beneficiary

h) Photograph and/or detailed description of service

i) Servicing/repair records

j) Rent/purchase option

k) Patient's date of birth

Include any and all additional documentation such as clinical notes, physician notes, discharge notes/orders, home health care nursing notes, copies of arterial blood gas or O₂ saturations, etc. If the information does not prove the equipment to be medically necessary, Medicare will request a full refund.

I strongly suggest hiring a professional consultant and an attorney to review and assist with these audit requests. Substantial overpayments have been collected from providers by all four regions because of poor documentation. Make it a practice to receive the appropriate documentation at the time of intake to ensure you can pass an audit when your name is selected.

— Answered by Jane Bunch, Jane's Billing & Consultation Services,
881 Jamerson Road, Marietta, GA 30066; 678/445-1221;
fax: 678/445-1222;
e-mail: billhme@aol.com; Web site: www.janesbandc.com

If you have an industry question you'd like answered by an industry expert, contact Marjory Garrison at HomeCare magazine, 23815 Stuart Ranch Road, P.O. Box 8987, Malibu, CA 90265-8987; 800/543-4116, 310/317-4522, ext. 160; fax: 310/317-0264; e-mail: mgarrison@primediabusiness.com