Submitted by D. Scott Jones, CHC, Compliance Officer
Top reasons CMS and our Medicare Administrative Contractor, Palmetto GBA, will deny payment for patient care already provided:
- Our notes did not include a complete description of why the care was “medically necessary”. A statement that includes “This treatment is medically necessary because…..” and lists reasons for care usually avoids this denial.
- We didn’t sign our documentation.
- We signed the documentation late, beyond the specified period (for example, some Rehab, Psych, or other services).
- We didn’t check with Palmetto GBA to determine if the service would be paid by Medicare before it was scheduled (for example, screening colonoscopy).
- If the service would not be paid for, we did not explain this to the patient and obtain a Medicare Advance Beneficiary Notice (ABN) authorizing the service.
- We didn’t follow Medicare Payment Manual guidelines for the documentation required to support the service provided.
Questions? Call your Compliance Team at x7455 or message sjones1@augustahealth.com