What to Compare Against
by AJ Riviezzo
As you know, we perform a number of chart-to-bill, bill-to-chart audits for consulting clients. A lot of the feedback we render is related to how well – or not so well – the documentation matches up against the clinical guidelines and Local Coverage Determination policies. In short, we look at what the local Blue Cross/Blue Shield Carrier and the Medicare Administrator’s polices are and check them against the History and Physical and the Operative Report.
This is a process you or your team members can do with a relatively small amount of work. Ensure you have the newest guidelines. Really break down the policy into its components. For example, if the guideline states that the treating physician is placing the patient in compression stockings, then you need to ensure you have notes that state you placed the patient in stockings, followed them, and the end results. Another example would be documentation noting HOW the patient’s symptoms impact the patient’s Activities of Daily Living. Noting that it does impact their ADL’s will not suffice. The key word is HOW, e.g. the patient cannot walk the dog, stand at work for long periods of time, etc.
Feedback from physicians that Medicare and Blues will not care about:
– I’ve been doing this for twenty years and no one has questioned my charts before.
– No one has been asking for that type of information until today.
– We didn’t know the policy had been changed.
– I thought the patient’s self-report of their conservative therapy program would suffice.
We agree that reviewing the documentation requirements is a bit burdensome. Changing your documentation is a royal pain. Having Blue Cross recoup $75,000 is not exactly priceless.
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