Features

You've (Probably) Got Mail

Have You Received Your Audit Request? If you have not received an audit request from AdvanceMed already, it is likely that you will. AdvanceMed is an
by Jane Bunch

Have You Received Your Audit Request?

If you have not received an audit request from AdvanceMed already, it is likely that you will.

AdvanceMed is an independent auditor hired to perform audits for the Centers for Medicare and Medicaid Services. The Comprehensive Error Rate Testing program, or CERT, allows CMS to monitor claims to ensure that they are accurate, and therefore, should be reimbursed.

Let's review to make sure your documentation meets the requirements to pass these audits — and so that your claims will be reimbursed.

Physician Orders

Physician orders must be complete and accurate. A 3"×5" prescription slip that reads “bedside commode, diagnosis: CVA (cerebrovascular accident),” even if it contains the patient's name and the doctor's signature, is not an acceptable order.

What does constitute a compliant physician order? Check your orders for the following:

  • Patient's name, address and Health Insurance Claim (HIC) number

  • Physician's name, address and UPIN

  • Quantity of the item to be dispensed

  • Frequency of use

  • ICD-9 code or narrative diagnosis

  • Specific type of equipment or supply ordered

  • Date of the order

  • Length of need

  • Physician's signature and date

  • Medical necessity of the item

Certificates of Medical Necessity

CMNs must comply to Medicare guidelines; providers can face large fines if they are not. Check your CMNs for accuracy and completion. As a provider, you must complete Sections A and C of any CMN before it is delivered to the physician's office for his or her signature and date.

In Section A, make sure to include:

  • Patient demographics

  • Place of service

  • Provider's information

  • Physician's information, including UPIN

  • Patient's date of birth, sex, height and weight

Section B must be completed by the physician or an employee of the physician. If someone other than the physician completes Section B, that person's name, title and employer must be stated. Section B also gives the medical necessity qualifications for the equipment being ordered.

Section C, to be completed by the provider, must state the equipment, supplies and accessories being ordered, as well as the Medicare allowable and supplier's charge.

Section D includes the treating physician's signature and the date of the physician's signature.

Topic: 
Issue: