CMS Clarifies Ordering and Certifying Documentation Maintenance Requirements
April 28, 2015 10:14 AM
The Centers for Medicare & Medicaid Services has issued Chang Request 9112 that provides instructions and clarification on their existing policy for ordering and certifying documentation maintenance requirement.
On May 5, 2010, CMS issued an interim final rule (CMS-6010-IFR) and on April 27, 2012, a final rule (CMS -6010-F), that established Medicare Ordering and Referring, and Documentation Maintenance Requirements.
CMS implemented a requirement that a provider or a supplier that furnishes covered home health services, items of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), clinical laboratory, or imaging services, is required to maintain documentation for 7 years from the date of service and, upon the request of CMS or a Medicare contractor, to provide access to that documentation. The requirement also applies to a physician who orders/certifies home health services, items of DMEPOS, clinical laboratory, or imaging services.
In the CR, CMS clarified the term “access to documentation” to mean that the documentation is actually provided or made available in the manner requested by CMS or a Medicare contractor. Examples of sufficient and deficient access to documentation are also provided in the CR.
The CR describes the process for requesting the documentation and provides a model letter the contractors are to send. Failure to respond to the contractor’s request within 30 days will result in a revocation of billing privileges for a period of one year. Current regulation at 42 CFR 424.535(10) provides CMS with authority to revoke a provider’s, supplier’s or physician’s billing privileges for failure to respond to a request for documentation outlined in 42 CFR 424.516(f) - Maintaining and providing access to documentation.
Since the IFR has an effective date of July 6, 2010, the contractors may not request documentation for written orders or certifications prior to July 6, 2010.
To view the CR click here.