Compliance Corner #2

Did you know? When you call Medicare to get ANY information regarding claims, customer service requires:

1. Your NPI
2. Your PTAN (medicare provider number)
3. The last 5 digits of your tax ID

Did you know? Intentionally or knowingly up-coding (selecting a code to maximize reimbursement when such a code is not the most appropriate descriptor of services offered) may result in immediate termination by contracted payers. Each healthcare provider must provide documentation to support the CPT, HCPC, and/or ICD9 codes used based on medical findings and diagnoses. Medical records documentation must be legible and completed in a timely manner.

Even with the risk of Medicare audits experts say that physician documentation improvements have fallen short of expectations. Inadequate documentation is not uncommon — whether it's too little overall or not sufficiently descriptive of the patient's problem. One pertinent point is that medical records must be "accurate, adequate and clinically useful”. Medical records must tell a complete story. It doesn't have to be prolific, just hit the important points and write adequate information that allows someone else to follow right along with what you have done.

More often than not, established patients are under-documented and that can result in huge losses for the practice.