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Thanks for the Visual

A friend of mine who practices health care law politely pointed out to me today that nowhere in CMS regs does it state that Physical Therapy must be rendered by therapists wearing clothes. Yet, try sending a nude therapist to a patient’s home and you will find yourself in regulatory hell. Thanks for the visual, Chris. I will have nightmares tonight.

My wise friend went on to say that at this point in time, the emphasis should be on over documentation as opposed to under documentation. Whether your concern du jour is RAC audits, payment, outcomes or state survey, your clinical records will determine your fate.

And of course attorneys and consultants have the luxury of really focusing on clinical records. We are not trying to schedule three resumptions on an afternoon when two nurses called out sick. We do not have to verify visits to ensure that our staff gets paid. When troubled clients call us we ask them to schedule an appointment. An agency nurse should have her ears boxed for taking that approach with a distraught family member. So when exactly do you look at clinical records?

A quarterly review is better than nothing but you are hard pressed to go back and draw lab that was ordered and missed two months ago. But, a quarterly review will give you the information you need for educating your staff.

Daily review of visit notes as they are submitted to the office will avoid a lot of problems but not all. A note can seem perfect outside of a chart and in the context of the entire record it is lacking important information.

But you have to bill every sixty days. There are requirements that the care provided during an episode meet the standard of being reasonable and necessary and that care be rendered under the orders of a physician. This is the perfect time to read through the last episode to ensure that the documentation is complete and meets guidelines. Certain tasks can be delegated to non-clinical folks such as ensuring that orders are signed and that all visits are in the chart. In doing this, the nurse has to read only an episode worth of notes to ensure that the care plan has been followed and that documentation meets Medicare payment guidelines as well as the guidelines of any other payor source.

When cash is tight and nurses are scarce, it is tempting to omit this last step of a billing audit. Nowhere in CMS does it say that a nurse must audit the chart. But, when your turn comes to be viewed under a regulatory microscope, it would be best if you had all your clothes on or you will find yourself in regulatory hell.

NOTE:  Christopher Johnston, one of my favorite attorney’s is available at the Gachessin Law Firm in Lafayette, LA.  I hope you never need him but if you do, here is his phone number:  337-235-4576 or   If nothing else, he is good for disturbing visuals you can share with your staff to drive a point home.

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