Avastin 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 Avastin.
| Avastin | 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? |