Medicare clarified support surface policies and coverage requirements

Area of Science:

• Healthcare policy and administration
• Medical device compliance

Background:

• Medicare beneficiaries require pressure-reducing support surfaces.
• Previous Office of Inspector General (OIG) reports identified significant deficiencies in medical record documentation for these devices.
• The Centers for Medicare & Medicaid Services (CMS) has issued new educational materials regarding ordering, coverage, and documentation requirements.

Purpose of the Study:

• To inform healthcare providers of updated requirements for ordering pressure-reducing support surfaces.
• To emphasize the importance of accurate medical record documentation to ensure compliance.
• To alert providers to the increased likelihood of audits concerning these support surfaces.

Main Methods:

• Review of Local Coverage Determinations (LCDs) and associated articles.
• Consultation of the Medicare Learning Network's Special Edition SE1014 educational article.
• Verification of patient medical records for complete physician orders and proof of medical necessity.

Main Results:

• A significant percentage of medical records are deficient in required documentation for pressure-reducing support surfaces.
• CMS has provided specific educational guidance to address these deficiencies.
• Audits related to the ordering and documentation of these surfaces are anticipated to increase.

Conclusions:

• Providers must proactively review all relevant LCDs, articles, and CMS educational materials.
• Ensuring complete and accurate physician orders and medical necessity documentation is crucial.
• Immediate refinement of support surface ordering and documentation processes is recommended to avoid compliance issues.