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. 

Common Error
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.

Common Errors

  • Billing for the actual date performed instead of billing on the date that is required to bill
  • Provider waiting until day 30 to bill and using day 30 as the billing date instead of the date the patient was actually seen
  • Missing documentation to support there was some sort of contact with the patient within two business days of discharge from the inpatient hospital addressing patient status to support the billed transitional care management services

For additional information on billing and documentation requirements, please refer to
Transitional Care Management.

Psychiatric Admission
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.

Common Error
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.

Common Error
Missing required contents on the Certification and Recertification.

Please refer to SNF Services for further assistance.

Hospice Care
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.
 
Common Errors

  • Missing the election of benefits which has been completed and signed
  • Missing the physician-signed certification or verbal certification
  • Missing the face-to-face physician encounter clinical notes

Please review Electing the Medicare Hospice Benefit and Hospice Documentation Audit Tool for further assistance.

Defibrillators/AICD—NCD 20.4
Common Errors

  • Providers are not submitting physician progress notes to support the medical necessity of the device
  • Missing formal shared decision making encounter between the patient and a physician using an evidence-based decision tool on ICDs prior to initial ICD implantation

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.

Common Error
Providers need to submit the credentials of the PMR.

Please review IRF Required Documentation for further assistance.

Attestations
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.

Common Errors

  • Providers are not sure what this is or what is required
  • Providers are altering the documentation and submitting documentation with signatures after the initial documentation was sent to CERT with a missing signature

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.

Common Error
Providers are not submitting orders for dialysis.

Please review ESRD Billing and ESRD Payment for further assistance.

Cataract-66984-LCD 34413
Common Errors

  • Need documentation to support the beneficiary’s own assessment of his/her functional status (usually in the form of a patient questionnaire)
  • Providers are not submitting documentation of what is requested on the ADR to support the billed claim. Providers are only including documentation for the billed DOS.

Please review Cataract Removal for further assistance.

Contact Palmetto GBA JJ Part A Medicare

Provider Contact Center: 877-567-7271

Email JJ Part A

Contact a specific JJ Part A department



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