Compliance Week Four – Billing Audit Checklist

Corresponding Standards

BC 1 – Accurate and Complete Billing Records PS 6 – Client Medical Records DEL 1 – Delivery Documentation

Complete / Indicator / Corresponding HQAA Standard / Findings / Action/Outcome
Audit 10-15% of your billing files to check for the following:
Physician orders:
ü  Patient name / PS 6
ü  Description of the item(s) ordered / PS 6
ü  Physician’s name / PS 6
ü  Start date of order / PS 6
ü  Prescribing physician has signed and dated the order / PS 6
ü  Does the order include the length of need, if required? / PS 6
ü  Was a written order required prior to delivery? If so, was the written order received prior to delivery? / PS 6
Proof of delivery:
ü  Patient’s name / DEL 1
ü  Quantity delivered / DEL 1
ü  A detailed description of the item being delivered—include the brand name and serial number, when needed / DEL 1
ü  Is the date of signature and the date the item was received by patient/caregiver on the delivery documentation? / DEL 1
Claim form:
ü  Patient name / BC 1
ü  Patient HIC/certificate number / BC 1
ü  Date of delivery / PS 6
DEL 1
ü  ICD correct / BC 1
PS 6
ü  Physician name / PS 6
ü  Quantity / PS 6
ü  Place of service code
Information from HQAA Director of Compliance
Physician orders:
∗ Someone in the employment with the physician, other than the physician, may complete the detailed description of the item; however, the treating physician must review the detailed description and personally sign and date the order to indicate agreements.
∗ Oxygen CMNs – include in section C (e.g. ICD diagnosis code, narrative description of the patient’s condition, abilities, limitations) is NOT in itself considered to be part of the order although it may be put on the same document as the order.
∗ Ensure the written order has been both signed and dated by the treating physician before billing the Medicare program. If not, the item will be denied as not reasonable and necessary.
∗ Products with certain HCPC codes must have written order prior to delivery. Your CMS DMAC supplier manual has the list of products by HCPC that fall into this category.
Proof of delivery:
∗ In instances where supplies are delivered directly by the supplier, the date the patient received the supply shall be the date of service on the claim.
∗ Proof of delivery for the shipped item(s) can be documented by having the shipper’s tracking number on file.

COMPLIANCE:WK4:KW:04-09:NT:REV:07-11:REV:NT:10-11