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Reducing Provider Burden

Updated 05/10/2018

We’re committed to limiting the burden caused by Medicare documentation requirements and our medical reviews that help us protect Medicare Trust Funds for future generations. Here are some things we’ve done and what we’re working on now

Recent Initiatives

Provider Documentation Manual – Home Use of Oxygen – Public Comment Period Now Open

We are listing all the documentation that’s required for Medicare payment in one central location – the Provider Documentation Manual. This will be a new Internet Only Manual. The first DRAFT section in this new manual is Home Oxygen Therapy. Each section will be on a specific item or service. We hope physicians/practitioners and suppliers can use these resources to ensure all relevant information required to support Medicare coverage of home oxygen is documented.

The purpose of the Provider Documentation Manual is to reduce the need for providers and suppliers to access many separate CMS documents to determine what is required for Medicare payment. Instead of searching multiple Internet Only Manuals, regulations, LCDs, and NCDs, providers can go to ONE place. Each section will include a checklist that provider/suppliers can use to ensure their documentation is complete. The Provider Documentation Manual does not replace policy/coverage manuals and does not create any new requirements. Using the Provider Documentation Manual is optional.

Please join us on May 10 at 2pm for a special Open Door Forum to introduce the Home Oxygen Therapy section of the Provider Documentation Manual (See Slides below). For more information on the Open Door Forum please visit: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODFSpecialODF.html

Please give us your feedback on the draft Home Oxygen Therapy section. Please send your comments to ProviderDocumentationManual@cms.hhs.gov by May 31, 2018. After we receive public input, we will revise the manual and post the final version.

Please refer to our documents:

Targeting Medical Review (Targeted Probe and Educate)

In October 2017 we launched a nationwide program to better target medical review, limit the number of medical records requested, and put an emphasis on education and assistance in correcting claims errors. This program focuses on providers who have unusual billing patterns or billing practices that vary greatly from their peers.

Get the details on this new targeted review process.

Deprioritizing Certain Providers from Medical Review (Medical Review Reduction Pilot)

In January 2017 we started an 18-month pilot to reduce medical review for providers participating with certain Advanced Alternative Payment Models. Read more about it in the Medical Review Reduction Pilot Fact Sheet and the  FAQs 

Simplifying and Clarifying Documentation Requirements

We are working to reduce paperwork with simplified, streamlined Medicare documentation requirements for claims payment. If you find requirements complicated, repetitive or unnecessary, submit your suggestions to ReducingProviderBurden@cms.hhs.gov to help us simplify requirements.

What we’ve done:

Visit our webpage on Simplifying Documentation Requirements for more information.  

Creating Detailed Denial Reason Statements

In 2015 we began to standard the reason codes and statements to help you better understand why claims were denied. If you deal with multiple CMS contractors, understanding the many denial codes and statements can be hard. Find out more about this project.

Posting Proposed Recovery Audit Review Contractor (RAC) Review Topics

On November 9, 2017 CMS began posting a list of review topics that have been proposed, but not yet approved, for RACs to review. These topics will be listed, on a monthly basis, on our Provider Resources page along with details about the proposed reviews, such as:

    • Name of the Review Topic
    • Description of what is being reviewed
    • State(s)/MAC regions where reviews will occur
    • Review type (complex review/automated review)
    • Provider type
    • Affected code(s)
    • Applicable policy references

Find out more about the Recovery Audit program.

Creating Clinical Templates and Data Elements

Printable clinical templates and suggested Clinical Data Elements (CDEs) are available to assist you with data collection and medical record documentation:

  • IT vendors: Integrate the CDEs into Electronic Health Record (EHR) systems to remind providers what they need to document
  • Providers:  If you are not using an EHR, you can print a template, fill it out, and file it in the patient’s medical record

 

Clinical Template and CDEs are currently available for:

  • Home health
  • Glucose monitors
  • Oxygen
  • Lower limb prosthesis; and
  • Power mobility devices

Facilitating Electronic Medical Documentation Interoperability

We support electronic medical documentation initiatives to help improve documentation submissions. Improved documentation prevents claim denials. You can join a pilot program and test sending documentation to other providers in the Electronic Medical Documentation Interoperability Initiative. You can also learn how to send documentation to CMS review contractors through the Electronic Submission of Medical Documentation (esMD) program.  

Final Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards for Therapeutic Shoe Inserts (1/09/2018) 

CMS recently revised the DMEPOS Quality Standards to account for therapeutic shoe inserts made with current technology.  The Final DMEPOS Quality Standards were effective January 9, 2018.  The Final DMEPOS Quality Standards and a document summarizing the comments we received during the consultation period and our responses are below. 

 

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