Supporting Documentation is an important piece of your business. Our infusion and specialty pharmacy customers have a bit of an advantage over our HME customers in obtaining supporting documentation; obviously, a pharmacy cannot dispense a medication without a prescription. Supporting Documentation exists in CPR+ in two specific formats: the Medicare required CMN and the more generic SMN (Statement of Medical Necessity). I will be focusing specifically on the SMN for this article.

The Statement of Medical Necessity in CPR+ gives the user the ability to obtain documentation that is as simple as a written order, or as complex as a CMN in providing answers to pertinent questions of medical necessity. The SMN template is comprised of two different areas: the items being ordered, and the aforementioned statement of medical necessity. The recommendation in building templates for these items is to make a generic template for each type of service being provided: diabetic supplies, enteral therapy, etcetera. Add to each of these templates a statement that outlines the medical necessity for the ordered items. This tool assists in getting orders for all of your items at the time of initiation of therapy.

The statement of medical necessity is created from the Databases Menu > Popup Windows > Statement of Medical Necessity. Each statement of medical necessity has a title, or a reference line that allows the user to quickly identify the equipment or therapy to which the statement refers. A statement of medical necessity for a bedside commode, for example, would include information regarding the patient’s mobility condition - if the patient is floor confined, room confined, or if there are no facilities in the home. This information is necessary to establish medical necessity of the item. Additionally, other statements of medical necessity would include information specific to the equipment. The creation of the statements of medical necessity is to be made in such a way that one statement could generically be used for multiple therapies or multiple pieces of equipment.

To associate a statement of medical necessity with a particular product or service, one would return to the Databases Menu, select Templates, and then select the SMN Templates option. Within the SMN template the user may add items including a quantity and the frequency of change. Then, the user would associate the appropriate statement of medical necessity using the pop-up. This template is now ready to be assigned to an item in inventory or to an item within the Special Price Matrix.

CPR+ uses the setup information in inventory or in a Special Price Matrix when determining what supporting documentation is necessary for an item. This determination is done when an item is used to create an order or when an item is added to a working Delivery Ticket. This process consists of a complex set of rules in the software. I will attempt to simplify it as well as I can. CPR+ auto-generates Supporting Documentation (and auto-statuses Delivery Tickets) based on a few setup options. Commercial payor’s documentation generation is set in the Special Price Matrix, item by item. This is accomplished via assigning the “SMN” option to the item and then selecting the appropriate “Template”. Supporting Documentation for Medicare payors is determined by the assignment of the appropriate item in the Inventory setup.

An SMN is auto-generated when no required document exists, or the document is signed and the item/HCPC is not already on the document, or the document is expired. So, if you already have a valid document on file (signed or not), and you create an Order or add an item to a Delivery Ticket that requires an SMN, CPR+ will create a new SMN, unless the dates are the same (From Date or Order Date, see below). This is done because CPR+ assumes that if the document was created on a prior day, the document has already been sent to the doctor for signature.

When the From Date on the Delivery Ticket or Order Date on the Order matches the SMN Date, additional logic considers that if a document exists that is not signed or expired, and the HCPC is not listed on that document, then CPR+ adds the HCPC to the document (does not create a new document).

The CMN/SMN Tracking List in the Enterprise List Manager allows you to track all SMN’s for missing signature and impending expiration. This tool allows the user to work proactively on obtaining updated documentation and inactivating older documentation. This is designed to eliminate the need of double checking-signature dates and validity of items on supporting documentation. If you would like further clarification or just want to talk through the process, you can contact the Support Trainer @ 877-277-4876 or training@cprplus.com.

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CPR+ has almost 300 built-in reports to choose from, with good descriptive headers. But what if you’ve set the report aside for a few days, or someone else has run it for you, or you’re a new user just learning what information you can get out of CPR+? In these cases, you might question what exactly the report is telling you. Starting in version 8.1a of CPR+, we’ve added an option that answers these questions.

Any user with appropriate permissions can activate an optional message that appears in the page footer of the last page of the report that describes the report contents specifically. The option is a user preference. If you want to try it out, just select Databases (7) from the main menu, Employee Data / Security Setup (8), select your name, and click on the Options tab. Click the check box for Show Report Description in Footer.

Here’s a sample report footer, from the Census report:

Click here to view a larger version of this report.

We’re adding the report descriptions to CPR+ as we go through the process of reformatting them to make them more visually appealing. Most of the Clinical Reports are finished and we’re plugging away at the Billing Reports now. We’ll have them all done no later than the final release of the Line Item Financials option.

You can check out this new feature if you’re on version 8.1a or later.

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