Wiki Dermatology pre-pay audit

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ndebien

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As some may be aware, Medicare has a pre-pay audit on E/M codes rendered within a global period for derm specialty. I recall stumbling across an article/form indicating that these claims can be dropped to paper and submitted with the required records, vs. submitting electronically and waiting for the ADR request letter. But for the life of me, I am unable to find that to tell me proper procedure in doing so right now. Anyone out there familiar with this? :confused:
Thank you in advance!
 
We starting doing something similar to this a couple years ago, but gave up because they were constantly telling us they didn't get the paperwork.

The way it worked is that you had to fill in a certain field on the electronic claim (maybe the local use field; I don't remember with certainty) with a code that indicated you were sending paperwork. Then you faxed the accompanying paperwork.
 
I would be very interested in seeing this too, since I thought the flag to set on the claim record was indicate there was additional information submitted, but the pre-pay reviews were strictly triggered by certain CPT codes. The old apples and oranges situation.
 
Look up PWK for your Medicare contractor. I submit records via fax to our Medicare contractor on occasion. It may vary contractor to contractor so look yours up specifically.

You have to flag the electronic claim that a fax of medical records will be coming. Your Medicare contractor will have a fax form to fill out & then use as the cover sheet when sending the fax. You have to create a unique identifying number that you will enter in the electronic claim & have on the fax cover sheet form that you fill out.

The fax of records has to be sent within a certain amount of time of filing the claim electronically.

You will have to find out from your claims software vendor where you load the required information in the electronic claim.

The documentation on your Medicare contractors website should have all the detail you need. Search PWK.
 
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