Dealing With Documentation Issues In The DME Industry

Monday, June 22nd, 2020
nurse or doctor holding a stack of files in folders

When it comes to DME and HME regulations, documentation can be one of the most frustrating aspects of compliance. If suppliers don’t show proper documentation for the necessity of providing an item, there can be serious repercussions with CMS.

What happens when documentation isn’t complete?

Compliance issues aren’t always about fraud or abuse. Sometimes, a doctor (or another professional involved with a DME prescription) simply misses a step. When this happens, the prescription can be flagged and the patient will be unable to get the equipment or supplies they need. Here is an example where compliance is not maintained because of a missed step.

A prescription is made for a patient for a specific piece of equipment. The DME supplier suddenly can’t bill the payor for that prescription. They are told that one question was missed by the doctor. But, it is not legal for the doctor to be told the question they failed to ask and get the answer from the patient. This would look like the doctor is leading the patient to a specific answer.

The supplier cannot be paid for the equipment and the patient ultimately suffers the most because they cannot get the supplies they need. Documentation issues not only prevent patients from getting what they need, but they can also cause DME suppliers to completely shut down.

Solving the real issues

For payors, the real issue is making sure that fraud is caught and stopped. This, of course, is a worthy cause to fight for. For DME suppliers and patients, the situation is different. Clarity is needed in the healthcare system to prevent patients from suffering and doctors, suppliers, and other entities from losing their businesses. All employees should be aware of exactly what is needed to stay compliant with CMS regulations and others.

Unfortunately, the answer isn’t simple. Some advocate for a single-payer system, where all information can be found in one place. This could make paperwork easier to complete, but it won’t solve everything. Others suggest that having a centralized information system for the entire healthcare industry while keeping the current payor system would solve the problem.

What your organization can do

There are things that your organization can do to stay compliant, even in an unclear environment. Here are some of the ways to do this.

  1. Make sure you have the right staff in the right positions. Your employees should be aware of all regulations that affect their duties and be prepared for changes in the industry.
  2. Use reporting and data to improve your processes. You can look at productivity, revenue, payor denials, and more. The goal is to track all aspects of your organization to see where you can improve, avoid payment denials, and increase patient care.
  3. Stay up-to-date on changes and laws. It is vital for both you and your staff to always research changes within the industry, including laws and regulations. However, doing so can be time-consuming. This is where the next step comes in.
  4. Work with a healthcare attorney. These professionals understand the difficult nature of your industry. They will stay up-to-date on changes so you can focus on providing the best care to your patients.

Would you like to speak with a professional attorney?

If you are a DME supplier and would like assistance in staying compliant, contact Brown & Fortunato today. Our Healthcare Attorneys have the experience, knowledge, and drive to make sure your operations are always compliant. You can reach us at (833) 228-6300 or Contact Us by email to learn more.