Medicare Compliance & Reimbursement
Know the Facts on Medicare and Medical Records Reviews
Question: Since the COVID-19 public health emergency (PHE) is still ongoing, and many have suggested it will be extended through the end of the year, does our practice really need to worry about medical record reviews by the Centers for Medicare & Medicaid Services (CMS)? New York Subscriber Answer: Although CMS put many investigations and reviews on pause during the pandemic, the agency is again looking into medical record reviews. The agency may be looking at medical records of Medicare Parts A and B beneficiaries through additional development requests (ADRs) and Targeted Probe and Educate (TPE) programs for rationale to support skilled services, says Kris Mastrangelo, OTR/L, LNHA, MBA, president and CEO of Harmony Healthcare International. You know CMS works with Medicare Administrative Contractors (MACs) for claims processing and other administrative functions. Your respective MAC would probably be a key connection point in assisting CMS with local claims, as well as reviewing the first level of appeals adjudication functions, Mastrangelo says. Most of the medical record information that may be reviewed can be found on form UB-04 and includes: Resource: Check out this CMS guidance at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/ Downloads/TPE-QAs.pdf.
Medicare Compliance & Reimbursement
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Know the Facts on Medicare and Medical Records Reviews
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