Neurology & Pain Management Coding Alert

Question: What’s the best way to respond to a documentation request from another physician or facility?

Mississippi Subscriber

Answer: Providing sufficient information when responding to a records request is important both for patient health and for your practice’s revenue management. If another provider or facility or other entity, like the Center for Medicare & Medicaid Services

(CMS) Comprehensive Error Rate Testing (CERT) program, requests additional documentation, there’s a good chance that whoever submitted the initial claim left out information that is necessary to include in a patient’s health record.

Louis Blank, who works for CMS, appeared in a Provider Minute video, where he listed these four tips for responding to such requests:

• Send all associated documentation. Something you may be unsure about including may actually be the crucial piece missing, Blank said.
• Respect the timeline request.
• Review the documentation before you submit it. The documentation should answer the questions of who, what, where, why, and how, Blank said.
• Ensure that the information provided verifies each item or service billed, as well as the medical necessity for each item or service.

Medicare Administrative Contractors (MACs) can provide more specific or individualized information, if necessary, Blank said.

MAC CGS offers these tips for documentation:

• “Provide ALL pertinent medical records/documentation and any additional documentation to support the specified claim.”
• As “the provider that billed the claim is responsible for maintaining all documentation necessary to support the services billed on the claim, in some cases, you may need to obtain records from a different provider (e.g., referring/ ordering provider or rendering provider/facility) and/ or for dates prior to and/or after the billed date of service.”
• “When you send documentation, always include the barcoded cover sheet as the first page. This allows the CERT Documentation Contractor to identify the correct beneficiary/ date(s) of service to which the documentation applies.”