Keeping Up with Medicare Documentation Requirements: How Electronic Attachments Can Help

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The Medicare Recovery Audit Contractor (RAC) program, made permanent by the Tax Relief and Health Care Act of 2006, is intended to identify improper Medicare payments, whether overpayment or underpayment. These contractors will require access to three years of provider claims and are paid on a contingency fee basis. Insurance claim documentation requests are therefore more prevalent than ever. One way for providers to better deal with Medicare documentation requirements is to digitize supporting documentation along with patient medical records, with the help of electronic attachments.

The healthcare industry is already digitizing many of their business processes to improve efficiency, with advances in electronic charting, electronic patient medical records, and the electronic submission of medical claims to insurance companies. Many insurers are now requiring electronic claim submissions since processing a claim manually costs nearly three times more. Submitting electronic claims and attachments increases efficiency and ultimately speeds up health insurance reimbursement, which can save time and save money for providers and payors and result in a better experience for patients as well.

So where do Medicare documentation requirements come into the picture? The nationwide implementation of CMS’s RAC audits has drastically increased the number of document requests that a large or small provider has to deal with on a regular basis. As of November 2010, limits have been put in place to cap the number of records requested by auditors in a 45-day period, since providers and the CMS were becoming overwhelmed with paperwork. This is still a large number, but this limit demonstrates just how much work dealing with the Medicare documentation requirements can be.

By digitizing documentation and patient health information, a healthcare provider can ensure both increased efficiency in dealing with insurers, and preemptively make things easier for future RAC document requests. This is in addition to the typical increases in efficiency on both the provider and payor side that come with the implementation of electronic claims filing, a benefit of this new era of technological support for healthcare business practices.

Additionally, digital attachments can be easily formatted according to industry formatting, security standards, and related government regulations. Healthcare policy is changing quickly these days, and keeping up with HIPAA laws and Medicare documentation requirements is an important part of doing business in the industry. Any system that will decrease the likelihood of lost documentation and mistakes will make things easier on providers and payors in the long run, and electronic attachments are an important part of this solution.