Fedor: Is the Documentation Playing Field Level?

Posted on in Billing/Reimbursement

documentation-playing-fieldHow do you respond when clinicians (referral sources) say that you are asking for much more documentation than other DME providers? You probably tell them that you are just asking for what is required, right? And their response back to you is, if so then why are some other providers accepting much less (thorough) documentation? As a provider trying to do the right thing and follow the rules this places you in a very difficult position. You must obtain all the required documentation otherwise you risk denials or overpayments in audit and this could jeopardize your business. However, you need those referrals to run your business. As you already know, the rules/regulations/policies apply to every provider. Then how can some provide products without following the rules and how are they getting away with it? But are they really getting away with it? Well in the short term, it appears so, as they are getting those referrals, providing the product and getting paid. While this may be true and frustrating you wonder if there is anything you can do to combat this. The answer is yes there are some things you can say and do to educate your referral sources.

  1. Tell them that you are doing what is required to ensure qualified patients receive the necessary equipment and don't have to worry about any extra financial liability due to a denial or worry about the possibility of losing the product due to a denial or audit recoupment
  1. Tell them that you agree that these requirements are burdensome, however, we want to be here in the future to serve patients and if we don't do it correctly, we won't be
  1. Remind them of a very large national wheelchair provider that for years appeared to not be obtaining all the required documentation (asking for less documentation than their competitors) and after being audited by Medicare and the OIG they are now out of business with their customers struggling to find someone to service their products
  1. Let them know that you don't want to be in that position in the future, and that is why you are asking for all that documentation
Again when some providers are not concerned with obtaining all required documentation it is frustrating but if you explain to the referral sources that you are only doing what is required maybe they will understand and respect your decision to do the right thing for your company and for their patients. To discuss this situation further please contact me at or 844-794-8459.