Advanced Search

Home Health & Hospice Week

Industry Notes

Published on Fri Apr 02, 2010

• Clinical review judgment (CRJ) may help you if your claims get caught up in medical review, but only if you submit the right documentation. What it is: CRJ involves two steps, CMS says in May 14 Transmittal No. 338 (CR 6954) -- "(1) the synthesis of all submitted medical record information ... to create a longitudinal clinical picture of the patient, and (2) the application of this clinical picture to the review criteria to make a reviewer determination on whether the clinical requirements in the relevant policy have been met." What it's not: "Clinical review judgment does not replace poor or inadequate medical record documentation," CMS stresses in related MLN Matters article MM6954. "Nor is it a process that review contractors can use to override, supersede or disregard a policy requirement." The transmittal is online at www.cms.gov/Transmittals/downloads/R338PI.pdf and the MLN Matters article is at www.cms.gov/MLNMattersArticles/downloads/MM6954.pdf.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Home Health & Hospice Week

View All