Compliance Audits the Face-to-Face Encounter

Compliance conducts internal audits as an ongoing process of evaluation and assessment to identify and deter inappropriate behavior and ensure the effectiveness of education and corrective actions.

Monthly, Compliance completes a comprehensive Post-Pay Claims Audit to ensure claims have been submitted to the insurance company for reimbursement correctly with required documentation. One document included in the audit is the Face-to-Face (F2F).

Face-to-Face Encounter

The F2F is the documented encounter between the patient and the practitioner. It must be dated within the preceding six months of the Durable Medical Equipment (DME) order and received from the practitioner within 45 days of completion. The practitioner documents subjective and objective information associated with diagnosing, treating, or managing a clinical condition for which the DME is ordered.

• Subjective data comes from the patient’s personal experience, views or feelings, such as their primary reason for the visit or chief complaint, the history of their present illness (HPI), the review of symptoms (ROS) and current medications.

• Objective data comes from factual information that is measurable and observable, such as vital signs, physical exam findings, test results and the review of documentation from other medical sources, such as the Seating and Mobility Evaluation.

The same practitioner who signed the Standard Written Order (SWO) and/or the Detailed Standard Written Order (DSWO) must be the same practitioner who signs the F2F with their credentials and the date the document was signed.

Digital signatures are permitted as long as they are generated by encrypted software that allows for verification.

These are typically an image of the providers signature, or their typed name followed by:

• Electronically signed by

• Electronically approved by

• Reviewed by

Typed signatures in a signature font or typed names accompanied by “Electronically signed on” with a date generated outside of encrypted software is not acceptable as a digital signature.

Each claim submitted to an insurance payer needs to support the equipment and/or services provided. Accurate submissions help reduce fraud, waste and abuse, but also helps ensure patients receive the right care at the right time. Correct documentation also helps protect Rehab Medical against potential audits and disputes as well as inaccurate or delayed reimbursement.