Billing without documentation

[KLS515]

I am looking for litature on the legal necessity of having the documentation of ANYTHING that is billed. I am needing to educate others on this. I can not find good information but I know it's out there! HELP

 

[Ms.M]

You might want to go on the cms website www.cms.hhs.gov or google search "billing w/o documentation.. Hope this helps.

 

[raptcatt]

Billing documentation

Not sure this is exactly what you are looking for but I have been doing some research for similar reasons.

http://findarticles.com/p/articles/mi_qa3977/is_200107/ai_n8991828
Payment strategies: Unscramble the alphabet soup of medicare payment systems
>
>The Medicare Catastrophic Coverage Act of 1988 requires health care professionals to include an appropriate ICD-9-CM code for each procedure, service, or supply billed to Medicare. To comply with the regulations, health care professionals must convert the reason the patient needs procedures, services, or supplies from written statements that include specific diagnosis, signs, symptoms, and/or complaints into ICD-9-CM diagnosis codes. The diagnosis code used should be the one at the highest level of specificity. If a 5th-digit subclassification is provided, the provider must use the 5th-digit code.

My research is ongoing so I'll let you know what else I find.

I think I found something more specific but can't remember where!

Thanks & in the same boat as you,
Melissa

diagnosis codes, diagnosis coding

 

[member7]

There is a little blurb under the Social Security Act section 1842 relating to the term clean claim that refers briefly to substantiating documentation.

http://www.ssa.gov/OP_Home/ssact/title18/1842.htm

Also, check out the Code of Federal Regulations under Public Health (42)

Hope this helps a little bit.

diagnosis codes, diagnosis coding