5T070, 5F070: Visits, Supplies, DME Billed Not Documented or Not Documented As Used

Documentation was not submitted to support the visits billed and needs to be corrected (Example: “Billed physical therapy & documented physical therapy assistant.”) Submit a corrected, hard-copy UB-04 with a 337 or 327 bill type with the medical records.

Note: Visits billed in error cannot be remod or deleted after an ADR request is issued but may be requested to be denied as billed in error.

To Prevent this Denial
In order to avoid unnecessary denials for this reason code when responding to an ADR, do the following:

• Ensure that documentation for all services billed is included with the medical records submitted
• A legible, dated signature is required on all documentation. Submit a signature log for any illegible signature issues

More Information

• Code of Federal Regulations, 42 CFR — Sections 409.43 and 484.18
• CMS Internet-Only Manuals (IOMs), Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Sections 30.2.1, 30.2.2 and 30.2.5 (PDF)
• CMS Internet-Only Manuals (IOMs), Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4 (PDF)
• CMS Medicare Learning Network (MLN) Matters article MM6698 (Signature Guidelines for Medical Review Purposes) (PDF)
• Medicare Medical Records: Signature Requirements Acceptable and Unacceptable Practices