Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 20, 2005 PDF

It's not a matter of if your carrier will audit you, but when, says Deborah Churchill, president of Churchill Consulting in Killingworth, CT. She offers the following tips for making sure your appeals are complete:

1) Review your local coverage determinations and make sure you're familiar with your carrier's documentation guidelines and utilization guidelines.

2) Make sure you include every listed element in the materials you submit.

3) Include a copy of your compliance plan--or at least the cover page and the section that corresponds to a particular procedure or issue.

4) Include a copy of your "dummy chart."

5) Include copies of the form(s) that the requested coding information is documented on.

6) Be sure that the patient's name and date are on every page.

7) Include all orders, and don't forget electronic orders.

8) Include all associated procedure reports.

9) Organize the materials.

10) Add explanations before each section, summarizing the medical necessity documentation and other information.