Lack of Documentation May Cause Loss of Dollars

May 12, 2008

Kathleen D. Schaum, MS
E 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 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:

• 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.

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Lack of Documentation May Cause Loss of Dollars | Filed Under InBusiness, Spring 2008 

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