Recently, we received the results from one of our clients who had the largest Medicare audit of accounts that we have seen to date at Comstar. In our past experiences, Medicare would request 1-3 trips as part of an audit.  In this case, as part of a random audit, they requested 40 trips from ONE (1) client.  Our client gave us permission to share the results of this audit with all of you. In this specific audit, Medicare reviewed 40 random trips of this client from 2015. Their audit resulted in retraction of 36 out of 40 of those payments. Those payments were retracted because of two reasons:

  1. “Did not have patient signature”
  2. “ Beyond the closest appropriate facility”

In this audit of 40 accounts, Thirty Five (35) of those trips did not have patient signatures. In the majority of the 35 cases a crew member DID record a reason for why the signature was not obtained. The reasons recorded for not obtaining a signature included:

  1. No stylus
  2. Weakness
  3. Patient Blind
  4. Cast on hand
  5. Pain
  6. With nurse/MD
  7. BSI
  8. Hand cuffs
  9. Blurred Vision

 

There was not further description of this finding beyond “did not have patient signatures”, so we can’t comment on why the reasons for not being able to obtain patient signature were not accepted.  However, one could assume that they were looking for some attempts via:

  1. Patient signs when physically capable, which may seem apparent in the narrative
  2. Patient signs with a Mark
  3. Family member or guardian signs on their behalf
  4. Receiving facility signs on their behalf

PLEASE NOTE:

  1. The four (4) claims that required no further action, i.e. passed Medicare audit, all had patient signatures.
  2. Medicare does have an Opportunity for Discussion and Education where providers can ask them to review their results and provide further explanation. As part of the Opportunity for Discussion and Education, auditors can overturn, change or uphold the prior decisions.

Click here to view AAA’s (American Ambulance Association) recommended signature form.  Providers may use this one or create one of their own.  This form provided by AAA is intuitive to the crews in terms of laying out a clear path for getting a signature.

 

TO READ MORE ABOUT MEDICARE’S AUDIT PROGRAM, CLICK HERE…

Medicare Fee for Service Recovery Audit Program

 

TO LEARN MORE ABOUT COMPLIANCE AND DOCUMENTATION REQUIREMENTS OR TO REQUEST A COMSTAR  COMPLIANCE CLASS IN YOUR AREA, FILL OUT THE FORM BELOW: