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CMNS and Other Documentation ~ a vignette Did anyone else see Steve Azia's letter to the editor in a recent issue of Homecare Magazine regarding the DMERCs asking for additional documentation beyond a qualifying CMN before reimbursement is granted? In my experience, it's not just the DMERCs who do this, either. For instance, we had a request the other day from a payer to submit a "certified" blood gas with the original signature of the therapist who analyzed it, even though we had already submitted both a signed, qualifying CMN from the ordering physician listing the blood gas results, and a copy of the blood gas certified by the medical records clerk, who pulled it from the patient's hospital chart and mailed it to us. No wait - it gets better. When we get this blood gas signed by the therapist we have to send that in with the original CMN, she tells me. "The original?" I asked. "Yes, the original" she said. "But you already have that -- we only had one original and we gave it to you" I told her. "Well, you'll have to get another one" she informed me. Sweet as pie, she was. "Is there something wrong with the one we sent you?" I asked. "No, but the certified blood gas has to be accompanied by the original CMN." I would have asked her if, in that case, she could send the original back to me, but I felt sure she would tell me it wasn't allowed to travel in either direction without a RT certified blood gas, and that we had broken some law by sending it with a certification by a mere medical records clerk. So I swallowed really hard and tried to be reasonable. "Um, can I ask why we can't use a blood gas signed by the medical records clerk as coming from the patient's hospital file?" "Let me let you talk to a supervisor" she said. "Okay." I sighed when I said that. In retrospect, that was a mistake. Surely they knew they had beaten me down when they heard that. Then the supervisor came on the phone. I repeated my query to him, and right away I could tell he liked to chat. What he told me was that long ago, in a galaxy far, far away (I'm obviously paraphrasing here) they did a survey (translation: they looked at 25 cases out of 2 million) and found that lots and lots of doctors (translation: more than 2) entered erroneous blood gas data on CMNs. So naturally, the obvious solution was to make life a living hell for the DME dealers. Okay, so he didn't really say that, but trust me, that was the gist of it. And who could argue with that? Right? So I took another tack. "Hmmm. Well why isn't there anything in the manual that defines "certified blood gas" as one signed by the analyzing RT?" I really thought I had him with that one.... but it was not to be. "I don't know," he said. "That's not my area." Well, of course not! What was I thinking? If it were your area you'd miss out on all the fun of defining things any way you please! No, I didn't really say that, but something inside of me sure did. Instead, I said thank you for your time and trotted off to see about getting the elusive, certified, notarized, and preferably, hermitically sealed blood gas results. It's okay, I thought to myself, someday we're all gonna have the last laugh when the truth finally hits them about what REALLY drives up health care costs. Roberta Domos, May 2000 |
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Domos
HME Consulting Group
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