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Printed Date: 9/22/2015
Avoid Coding Errors
When submitting your claims to Medicare for processing, please ensure the codes on the claim match the documentation that is in the medical records.
Billing for the wrong date of service or with the incorrect code.
Please see CERT Error: Incorrect Coding and Date of Service Reporting for guidance.
Transitional Care Management
It is important to bill for the date the patient was seen. Waiting until day 30 is not appropriate to use as that is not the correct date of service.
For additional information on billing and documentation requirements, please refer to
Transitional Care Management.
The initial psychiatric evaluation with medical history and physical examination must be performed within 24 hours of admission in order to establish medical necessity for psychiatric inpatient hospitalization services.
Missing the physician-signed multidisciplinary treatment plan.
For additional information on psychiatric admission, please refer to the Inpatient Psychiatric Facility Webcast for more information.
Skilled Nursing Facility Certifications and Recertifications
Skilled Nursing Facilities are expected to obtain timely certification and recertifications. Each certification must contain all pertinent information.
Missing required contents on the Certification and Recertification.
Please refer to SNF Services for further assistance.
There are two important key requirements of the Medicare hospice benefit: a physician must certify that the beneficiary is terminally ill and the beneficiary must elect hospice care.
Please review Electing the Medicare Hospice Benefit and Hospice Documentation Audit Tool for further assistance.
Please review NCD 20.4 further assistance and guidance.
Inpatient Rehabilitation Facility (IRF) Credentialing
Specific medical record documentation, at the time of an IRF admission, must support a reasonable expectation that the patient requires multiple intensive therapies, one of which must be physical or occupational therapy, the patient must be able to actively participate and demonstrate measurable improvement and requires supervision by a rehabilitation physician to assess and modify the course of treatment as needed to maximize the benefit from the rehabilitation process.
Providers need to submit the credentials of the PMR.
Please review IRF Required Documentation for further assistance.
Providers should not add a late signature to the medical record (beyond the short delay that occurs during the transcription process). Medical records must be signed prior to their submission to CERT. In many cases, when the signature is missing from the original medical record submission, the provider then submits an appeal with a copy of the medical record signed after the CERT review. This documentation is unacceptable and Palmetto GBA will contact the provider asking for an attestation statement.
Please review Physician Signatures for further assistance and guidance.
End Stage Renal Disease (ESRD)
The ESRD PPS includes consolidated billing requirements for limited Part B services included in the ESRD facility’s bundled payment. CMS periodically updates the lists of items and services that are subject to Part B consolidated billing and are therefore no longer separately payable when provided to ESRD beneficiaries by providers other than ESRD facilities.
Providers are not submitting orders for dialysis.
Please review ESRD Billing and ESRD Payment for further assistance.
Please review Cataract Removal for further assistance.
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Last Updated: 04/25/2019