Medicare requesting office records

heartyoga

Guru
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120
Location
Cookeville
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This is our first time to receive a record request (pre payment review) from Medicare. They requested 2 patients' office visit for which we appropriately billed 99214. I'm not sure if this is just a random audit. I can't help but think if this is related to a patient complaining non stop to Medicare because he didn't want to pay his deductible from a year ago.

Would appreciate any feedback or any one who has this experience?

Thanks.
 

CodingKing

True Blue
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3,899
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If its the same patient of the complaint then yea its related if not its not. As long as its coded correctly there's nothing to worry about.
 

thelton

Networker
Local Chapter Officer
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91
Location
Farmington, AR
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Check your local carrier's website. It should have the information regarding pre-pay audits. Our carrier, Novitas, has it listed under Medical Review, Upcoming Focus. The list is extensive including office procedures as well as multiple E/M codes. And watch your EOBs......you never get a letter giving the results....they either pay the claim or down-code or deny it. If they do down-code a claim and your documentation supports it, don't be afraid to request a redetermination. I use their own audit form and annotate the documentation to show each piece of the E/M service along with an appeal letter breaking down the E/M service. So far (knock on wood), this approach has been very successful not to mention I have the best group of doctors at documenting their services and showing medical necessity.
 
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