Health Information Management

News: Palmetto issues warning about documentation error rates

CDI Strategies, August 4, 2011

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Healthcare providers in the A/B MAC jurisdiction 1 have a problem—a paid claims error rate that’s nearly twice the national average for Part B claims, according to a recent letter from that region’s MAC coordinator Palmetto GBA. By far the primary reason for those errors, says Palmetto (which covers California, Nevada, Hawaii, Guam, and the Northern Mariana Islands), is the lack of adequate documentation to support the billed services.

“An error rate of this magnitude can quickly evolve into a negative perception of the quality of care provided to Medicare beneficiaries,” the letter states.
Palmetto’s strongly-worded communication states that the MAC will be taking an “aggressive approach designed to address the causes of documentation errors” including increasing the number of prepayment and post-payment record reviews “across all provider types and services.”
Palmetto indicated that insufficient documentation errors occur when:
  • A provider fails to respond to repeated attempts to obtain medical records
  • Medical documents submitted do not contain pertinent patient facts (patient’s condition, diagnosis etc.)
  • Medical documentation is illegible, has no date, is improperly signed, etc.
“You control the documentation describing what services your patients received, and your documentation serves as the basis for the bills sent to Medicare for the services you provided,” the letter states. “If your documentation does not support the services on the claim, then a payment error exists.”

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