Wiki ROS Question

[coder21]

I have a question say a doctor has in his ROS no cough, no sore throat, no fever, except all other ROS negative. Would you count that as 2-9 or a complete ROS?

Thank you

 

[RebeccaWoodward*]

My Medicare carrier allows a complete ROS with this statement.

 

[coder21]

Thank you

 

[RebeccaClendenen]

With one caveat

If you are in an area where the Fiscal Intermediary is Trailblazer and this is a Medicare patient, the "all other systems negative" comment will not be acceptable

 

[FTessaBartels]

Check YOUR carrier

Please be sure to check with YOUR carrier as this is carrier-specific.

Our carrier currently DOES accept this, but we've been notified that we'll be switching to Trailblazer next year and they DON't accept it. Training of MDs has started already.

F Tessa Bartels, CPC, CEMC

 

[coder21]

So what do you do for the commerical insurances? Do you just follow the Medicare rule for all your paitents?

Thank you

 

[RebeccaWoodward*]

Personally, I base all my chart review on CMS guidelines. 99.9% of my commerical carriers base their guidelines around CMS guidelines. Most of our local carriers state, on their websites , state that they mimic CMS guidelines...not our local MAC. When auditing Medicare patient's, I have to "weigh in" my local MAC's guidelines and CMS'. For the most part, their DG requirements are the same...there are only a few variations. My recommendation...follow CMS unless your local carriers, have in writing, that they adopt your local MAC requirements.