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Medicare Compliance & Reimbursement

Reader Question:

It's The Total Dosage That Counts For Prescription Strength OTC Medicines

Published on Wed Oct 10, 2012

Question: I am looking for assistance on this. I have a provider who has stated that if he recommends that a patient take OTC meds at prescription strength, such as Ibuprofen, this qualifies as "moderate" for decision making. I am looking for some guidance on this.Answer: Moderate decision making involves other factors besides the level of risk. In the typically applied carrier audit grid, there are three components that determine MDM. The number of diagnostic and management options, the amount and complexity of data, and finally the level of risk. He is correct that recommending prescriptive therapy can be moderate risk. However, at least two of the areas of MDM must be supported in order to qualify for a given level of MDM complexity. So you have to score all three components of decision making: Risk (here prescriptions are moderate risk), number of diagnoses and management options, and data.In order [...]
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