Documentation lookup effort takes shape

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Friday, October 26, 2018

WASHINGTON – A new initiative underway at CMS would make it easier for healthcare providers to look up documentation requirements, agency officials said during an Oct. 23 Special Open Door Forum.

The Medicare Documentation Requirement Lookup Service, still in the prototype phase, would pull together existing requirements, which are currently scattered among various manuals, National Coverage Determinations and Local Coverage Determinations, and present them in a machine-readable format within the electronic health record, according to CMS.

For example, a physician ordering home oxygen therapy for a patient would log into their EHR system to learn whether there are prior authorization and/or documentation requirements. The DLRS would show there is no PA requirement but that there are documentation requirements and would provide those requirements, along with any related templates.

At some point in the future, CMS officials said, they hope those templates could be prepopulated with information already contained in the medical record, such as lab results, so that they don’t need to be constantly re-entered.

CMS is currently recruiting EHR vendors, providers and health plans to participate in the DLRS pilot.

While all providers are welcome, CMS officials said they think the providers that will be most interested in participating in the pilot are ordering providers, like physicians, as opposed to DMEPOS suppliers who they say already know that the rules are and don’t need to look them up.

However, during a question-and-answer period, officials fielded several calls from DMEPOS suppliers, with one caller stating that the program would be “very beneficial” to his organization.