5620RE: [MedicalBillers] Physician Orders for EKG in Medical Chart
- Oct 4, 2011this is definitely not a medicare issue
order of any service/procedure to any patient is simply medical doctor 101, you write it down as being advised to have it done, not just do it and have a report.
nothing in this industry is verbally done. later if there is any liability, you would use this same info as proof
rule of tumb in the medical industry is that if it is not documented it never happened!
about your question:
first place usually a claim is billed appropriately and medicare simply pays
second place, this must be after the fact and then they did an audit chart review, asked you for medical records to substantiate the services?
If this is the case, then what is your original denial when you sent the claim, when the visit code was paid, what does it say next to the ekg?
Date: Mon, 26 Sep 2011 22:07:40 +0000
Subject: [MedicalBillers] Physician Orders for EKG in Medical Chart
Coder presented info regarding a CERT (Medicare) chart review at her clinic. Apparently, the office visit was paid, but not the EKG. It was performed at the same time, of the office visit, and there was medical necessity. However, Medicare said that because it wasn't ordered and documented in the medical chart, it would not be payable...regardless of the medical necessity. The chart note said that an EKG was done and the results were listed, but not that it was ordered (specifically).
Does anyone know anything about Medicare requiring this type of information (ordering of tests) in the medical chart? Also, can you provide me with a link or reference pertaining to this issue?
Your help is appreciated as I'm trying to assist another office.
Melinda Brown, CMBS
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