K0005 Pre-Billing Quality Assurance Checklist

Critical Deficiency: Signature Stamps

Do not submit documents with signature stamps unless the physician has a registered hand disability . If a stamp is present, you must obtain a signature attestation prior to claim submission .

1. Signatures & Dates (Strict Compliance)

• No Signature Stamps: Verify the SWO, Detailed Order, LCMP exam, and Face-to-Face (FTF) notes do not use signature stamps .
• Handwritten Dates: If a provider uses a “wet” (handwritten) signature, the accompanying date must be manually added/handwritten. A typed date next to a wet signature is a flag .
• Chronological Logic:
  • The Therapist signature date cannot pre-date the actual exam date .
  • The Physician signature on the LCMP exam cannot be dated before the LCMP exam was completed .
• Late Entries: If the physician signs the exam significantly later than the appointment (e.g., after the LCMP is done), ensure it doesn’t reference information only available after the FTF date .

2. Clinical Documentation Consistency

Story Consistency

The Physician’s FTF exam and the Therapist’s LCMP exam must tell the same clinical story. Discrepancies here are major audit flags.

• Pain & Sensation: Do findings match?
  • Flag: FTF reports “no pain/intact sensation” while LCMP reports “pain/neuropathy” .
• Musculoskeletal/ROM: Do findings match?
  • Flag: FTF reports “normal curvature/ROM” while LCMP reports “kyphosis/limited ROM” .
  • Flag: FTF reports “normal” musculoskeletal findings while ordering a custom K5 .
• Current Equipment: Is the history consistent?
  • Flag: FTF reports patient uses a “rollator” while LCMP reports current equipment is a “K0003” .
• Diagnosis Side/Dominance: Verify lateral consistency across all docs (Order vs. FTF vs. LCMP).
  • Check for mismatches in Left vs. Right side .
  • Check for mismatches in Dominant vs. Non-dominant side .

3. Medical Necessity (K5 Justification)

• Objective Muscle Strength: The file must contain objective muscle strength testing (MMT) for upper and lower extremities. “Normal” or “Intact” strength does not support a K5 .
• Need for K5 vs. Lower Level: Does the documentation explicitly prove why a K1–K4 chair is insufficient?
  • Warning: If patient is “Independent” in MRADLs or has normal strength, K5 necessity is not supported .
  • Warning: Ensure parts ordered cannot simply be placed on a lower-level chair .

4. ATP & Home Assessment Data

• ATP Measurements: The ATP exam must include patient body measurements. If missing from the main form, is a separate measurement document attached? .
• Home Assessment Completeness:
  • Are all narrative fields (above/below room accessibility) filled out? .
  • Are doorway measurements recorded for every listed area of the home? .

5. Administrative & Product Verification

• Therapist Name Match: Does the therapist name on page 1 of the LCMP match the signature on the Financial Attestation/Final Page? (e.g., Grace vs. Tim) .
• SWO Integrity: Ensure ICD-10 codes on the SWO were not handwritten/altered by someone other than the physician .
• PDAC Verification:
  • Does the Model # on the POD match the HCPCS code billed? .
  • Critical: Does the manufacturer actually have PDAC approval for that code? (e.g., verifying E2612 vs E2611 for Ki Mobility) .
  • Is there a valid quote on file reflecting the specific code? .

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Next Steps if Deficiencies Found:

• Signatures: Obtain a Signature Attestation immediately .
• Missing Measurements: Request separate measurement doc from ATP .
• Clinical Mismatch: These generally cannot be corrected post-audit; require a new exam or appeal correction .