Today's Wound Clinic - Spring 2008 - (Page 8)

inbusiness • May 2007: Medicare Payments for Surgical Debridement Services in 2004. • June 2007: Medicare Payments for Negative Pressure Wound Therapy Pumps in 2004. Unfortunately, both reports found that documentation in the medical records of wound care patients did not adequately support medical necessity of the procedure(s) performed and/or the product(s) ordered. The OIG found Medicare overpaid $64 million for false claims involving surgical excisional debridement and $27 million for false claims involving negative pressure wound therapy pumps and supplies. MEDICARE MEDICAL REVIEWS Numerous medical reviews have been conducted by Medicare contractors regarding surgical dressings that were not ordered according to the guidelines of the Surgical Dressing Local Coverage Determination (LCD) and its accompanying Article. Most recently, Medicare contractors have been requesting repayments due to the fact that providers have not documented the method of fixation for skin replacements and skin substitutes. Since these are considered surgical procedures, the payers expect to see fully documented procedure reports, including the method of fixation used to secure the skin replacements and skin substitutes. Some contractors recommend the minimal fixation (eg, steri-strips) they require while other contractors leave the decision up to the physician who applies the products.However,all Medicare contractors expect that the medical record will include documentation of the fixation method selected. Therefore, each wound care physician and clinician must take personal responsibility for reviewing the documentation guidelines that the payers provide. One should not become complacent with inadequate documentation just because all claims are currently paid. Remember, repayments can be enormous if medical records are audited and your documentation does not adequately support medical necessity for the fees that were paid. Lack of Documentation May Cause Loss of Dollars KATHLEEN D. SCHAUM, MS E 8 arly in their medical/clinical training, wound care physicians and clinicians learn the caution, if it’s not documented, it’s not done. Few physicians and clinicians, however, realize the enormous financial consequences that the lack of documentation can have on their practices if: • they perform self-audits and find that their documentation did not support the codes that were billed and the payments they received and/or • they receive a Medicare audit and find that their lack of documentation resulted in false claim submissions. In wound care settings a variety of physicians and clinicians practice as a team to achieve excellence. Each Spring 2008 Today’s Wound Clinic member of that team should take personal responsibility for clearly documenting the work they perform.These professionals should not only use the documentation guidelines learned during their medical training, but should also follow the guidelines of the payers who review their claims for medical necessity. Most Medicare contractors provide educational seminars, webinars, online training, educational documents related to documentation, medical policies, and articles that include documentation requirements. OIG WOUND CARE RELATED REPORTS In the middle of 2007, the Office of Inspector General (OIG) released several reports regarding the wound care industry:

Table of Contents Feed for the Digital Edition of Today's Wound Clinic - Spring 2008

Today's Wound Clinic - Spring 2008 Contents InTroduction InBusiness Documentation: The 30,000-Foot View Documentation: Clearing Up the Role of Compliance InTech InPhotography InFluence InStruction InNews InCentive Ad Index

Today's Wound Clinic - Spring 2008

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