Clinical Documentation and Audits – The Clinician Connection

Since the clinicians’ role is to provide care to patients and families at the end of life, why be concerned about a medical review audit by a Medicare contractor? Why worry about a survey? And what does any of this have to do with documentation? The answer is that payment can be denied when eligibility documentation is weak. Poor survey outcomes, as a result of incomplete documentation, put the hospice in a reactive and defensive mode. This session will address the connection between documentation and successfully surviving medical review by the various Medicare contractors (yes, there is more than your MAC) and the documentation connection to passing Medicare surveys. We will explore the role of a hospice’s monitoring and auditing processes in improving compliance at the clinician level.