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Printed Date: 9/22/2015
The following questions were received during our December 11, 2018 webcast.
Q: If the decision and education letter is not received after documentation is reviewed by Medical Review, how can we get a copy of that letter?
A: Normally, those are mailed out after the review. If for some reason you have not been able to find that in your office, you can contact our Provider Contact Center at 1-888-355-9165. Choose Option 5 for Customer Service, and they will be able to assist you with retrieving the decision and education letter for that denied service.
Q: I am a hospitalist and all my services are in the hospital. So when records are requested, why are they sent to me instead of to the hospital because this service was a hospital service?
A: Medicare contractors request medical records from the billing provider. They are the provider who rendered the service, they submitted the claim for payment, and request for documentation goes to that provider.
Medicare contractors request medical records from the provider that billed for a service. As a reminder, hospitalist and hospitalist groups are required to adhere to all documentation requirements as are all providers.
When requested, a hospitalist or hospitalist group is required to obtain and furnish documentation to support services billed to Medicare even if that means the hospitalist or hospitalist group must obtain records to support billed services from the hospital or other entity where the records are maintained.
Q: If the review determines that the records were not legible, would that be treated as no documentation available?
A: Usually, with illegible records, it will be considered missing or incomplete documentation. If we cannot read the notes then your service will be denied. If you feel your notes might not be readable, or if you know the handwriting, possibly, is difficult to decipher, then we would suggest you do a transcribed signed note by that provider. Submit that with your original. If you feel like there is an issue with the copy, than we really encourage you to try to get the best copy quality that you can. If you have that denial come through with the illegible documentation, you can submit those items on your appeal. You can send that original note, with the transcribed note that is signed by that provider.
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Last Updated: 01/08/2019