Great Job Caring For That Patient! Too Bad Medicare Won’t Pay For It…

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