In Coding
Nov 14th, 2016
As with most things, when documenting in the medical record, it’s best to “get it right” the first time. And because human memory isn’t as reliable as we’d like to believe, it’s also best to document the patient encounter as it is rendered, or as shortly thereafter as possible. When amendments, corrections, or delayed entries ...
Knowing the various entities reviewing your medical records for accuracy is half the battle. Any entity that is expected to pay your claims has the right to review the documentation that (hopefully) supports the services being billed. To prepare for the inevitable, you are wise to familiarize yourself with which entities may be interested in ...
In Billing
Mar 11th, 2015
If a Medicare Administrative Contractor (MAC), or certain CMS review contractors (e.g., Comprehensive Error Rate Testing (CERT) contractors, and Recovery Audit Contractors (RACs)), request additional documentation for a particular claim, you have just 45 days to honor the request, or your claim will be denied. CMS Transmittal 567 specifies, “When requesting documentation for postpayment review, ...
In Billing
Feb 2nd, 2015
If you submit claims to Medicare, know that you have 45 days to respond to an Additional Documentation Request (ADR) that you receive from a Medicare administrative contractor (MACs) or Zone Program integrity contractor (ZPIC). According to MLN Matters® MM8583, “Failure to respond within 45 days of a prepayment review ADR will result in denial ...
Healthcare fraud significantly affects federal expenditures, and ZPICs are here to investigate potential fraud and protect the Medicare trust funds. Kay Rankin, MD, MBA, CFE, AHFI, CPC, CPC-H Zone Program Integrity Contractors (ZPICs) are the Centers for Medicare & Medicaid Services’ (CMS) contractors that have the primary focus of investigating potential healthcare fraud and ensuring ...