Documentation

Documentation for Home Health Services (Part A non DRG)

The Medical Learning Network provides coverage guidance, which should be documented, for home health services.

Regarding inadequate physician certification/re-certification

Physicians or Medicare allowed NPPs must certify that:

Traumatic Subluxation Coding Controversy

There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated.

Combined Deskbook Resources

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Provider Documentation Guides (PDGs) Are Excellent Training Tools - Part II

PDGs, when properly used, can be tremendous tools to help providers document key pieces of information pertinent to identifying medical necessity for services ordered, performed, and billed. Using PDGs in provider training sessions can improve documentation habits, making proper code selection easier and medical necessity clear. Schedule and execute a quick, 10-minute provider session in the following manner:

Preparation:

I can count on two consistent issues in coding audits.  Doctors report that their patients are, in general, sicker than patients in other practices.

Medicare Improper Payment Report for Behavioral Health Services

The following information is from the 2014 Medicare Improper Payments Report by the Department of Health and Human Services.

This table shows the Improper Payment Rates by Provider Type and Type of Error for Medicare Part B claims:

    Provider Type

    Improper Payment Rate

Documentation Resources (Resource 365)

This page is only a general listing of documentation resources for behavioral health.  More thorough and detailed explanations are found in Section D-Documentation in the Behavioral Health MultiBook. Documentation is essential to establishing medical necessity and the level of services provided to the patient. Treatment plans and outcome assessments are crucial elements to thorough documentation.

 

Treatment Plan Alert -- Attention Needed

Problem

Denials and refund demands due to the failure to have a treatment plan (Care Plan) documented in the chart.

Subjective History

Over the years, Medicare and others have paid claims based on the information that was only on the claim form. Supporting clinical necessity details from the charts were rarely used.

Record Cloning and "Spinners" Attract CMS Gaze"

The Centers for Medicare and Medicaid (CMS) requires that all treatments it pays for be medically necessary. CMS normally reimburses fairly quickly, then audits submitted claims to detect cases where treatment should not have been authorized. Doctors demonstrate the medical necessity of their claims by submitting, when requested, the documentation on cases that the auditors have flagged. If submitted documentation justifies the treatments paid for, the claim will be upheld. If not, then the government asks for its money back, and fines may be imposed.

Was Your Claim Denied as a Duplicate Service?

On occasion (if not more often), every practice receives a notice of claim denial that reads, ‘duplicate service.’ When the insurance denies a service as duplicate but your records indicate that is not true, how should you act?

First, gather all pertinent information on the claim to determine a possible cause. The following are some reasons why the claim may be denied as duplicate:

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