Recovery Audit Contractor (RAC)
Medicare Documentation Requirements – Blood Glucose Testing
Provider Enrollment, Chain and Ownership System (PECOS)
Signature Guidelines
Recovery Audit Contractor (RAC)1
The Center for Medicare & Medicaid Services (CMS) has taken steps to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program by awarding contracts to four Recovery Audit Contractors (RACs). Section 302 of The Tax Relief & Health Care Act of 2006 made RAC permanent and required the Secretary to expand the program to all 50 states by no later than 2010. Each RAC is responsible for identifying overpayment and underpayments in approximately ¼ of the country.
The goal of the recovery audit program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care providers submit claims that do not meet Medicare’s coding or medical necessity policies. Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed. Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B.
Click Here for more information on RAC.
Medicare Documentation Requirements – Blood Glucose Testing2
Glucose monitor supplies have been one of the highest sources of errors in medical reviews performed by the Durable Medical Equipment Administrative Contractors (DME MACs) and the Comprehensive Error Rate Testing (CERT) contractor. CMS expects that physician records will reflect the care provided to the patient including, but not limited to, evidence of the medical necessity for the prescribed frequency of testing.
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Click Here for the DME MAC letter to physicians regarding medical records for glucose monitors and supplies.
Provider Enrollment, Chain and Ownership System (PECOS)3
Medicare Healthcare Providers are required to enroll in new Provider Enrollment, Chain and Ownership System (PECOS) by January 3, 2011
Why are you required to Enroll?
- Ensures payment accuracy for the services you provide to Medicare patients.
- You need an approved enrollment record in PECOS to continue to refer or order medical supplies or services for your Medicare patients.
- You may not be able to receive incentive payments from Medicare for meaningful use of certified electronic health records.
If you do not have a current, active Medicare enrollment record, it is imperative to take the necessary action as soon as possible, you can visit the Medicare site:
http://www.cms.gov/MedicareProviderSupEnroll/
For more information, visit:
http://www.cms.gov/MLNMattersArticles/downloads/MM6842.pdf
Signature Guidelines
CMS (Centers for Medicare & Medicaid Services) contractors are tasked with measuring, detecting, correcting improper payments, and identifying potential fraud in the Fee for Service (FFS) Medicare Program. On March 16, 2010, CMS (Centers for Medicare & Medicaid Services) provided clarification how Medicare reviews claims and documentation submitted by providers. This communication outlines the new rules for signature guidelines for medical review purposes and adds language regarding E-Prescribing. For medical review purposes, Medicare requires that services provided or ordered be authenticated by the author. The method used must be a handwritten or an electronic signature. Stamp signatures are not acceptable.
In addition, CMS clarification reference signature logs and attestation statements may accompany the documentation providers submit. A signature log identifies the author associated with an initial or illegible signature. An attestation statement must be signed and dated by the author (e.g., physician/practitioner) of the medical record entry and contain sufficient beneficiary information.
CCS Medical, Inc. would like to ensure that our physicians are provided with the most up to date information. For your convenience, we have provided a downloadable copy of a physician attestation statement and signature log.
Please click here to download the attestation statement form.
Please click here to download the signature log form.
For more information on the article, please see click on the following link:
https://www.noridianmedicare.com/dme/news/docs/2010/06
_jun/mm6698revised.pdf
1 http://www.cms.gov/RAC
2 May 2010, DME MAC letter to physicians on glucose monitors and supplies
3 http://www.palmettogba.com
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