Rituxan Checklist

Published 04/02/2019

Providers can use this checklist as an audit tool to help assure that they are submitting all documentation that is required to help prevent denials for Rituxan.

Rituxan Yes No N/A
Is the documentation for the correct beneficiary?      
Are the dates of service correct?      
Is the physician’s order present?      
Is the physician’s order signed and dated?      
Does the order include the dosage, frequency and route?      
Is there relevant documentation to support the need for the medication?       
Is the diagnosis present in the documentation to support medical necessity?      
Does the unit(s) billed correspond with the number of unit(s) ordered/administered?      
Is the patient’s body surface area (BSA) included in the documentation?      
Was the protocol followed to administer this drug?      
Are coverage requirements met for medical necessity?      
Is documentation present to show the administration of the drug and how it was tolerated?