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Below are some recent important updates from Palmetto GBA.
E/M Tip: Medical Decision Making
The guidelines do not state that Medical Decision Making (MDM) must be one of the key components documented; however, please keep in mind MDM will support/steer medical necessity.
E/M Tip: History Component- Use of Diagnoses
The Review of Systems (ROS) refers to signs and/or symptoms that the patient may be experiencing or has experienced, not a list of diagnoses (i.e., denies CHF (chronic heart failure), diabetes, etc.).
E/M Tip: History Component- Use of Diagnoses
The Review of Systems (ROS) refers to signs and/or symptoms that the patient may be experiencing or has experienced, not a list of diagnoses (i.e., denies CHF (chronic heart failure), diabetes, etc.).
E/M Tip: Chief Complaint
The extent of the information gathered for the chief complaint (CC) and history component is dependent upon clinical judgment and the nature of the presenting problem. The documentation must clearly reflect the CC
Stamped Signatures Not Acceptable!
Stamped signatures are not acceptable. Stamped signatures are only permitted in the case of an author with a physical disability who can provide proof to CMS or a CMS contractor of an inability to sign due to a disability.
Email Update Archive Available on Palmetto GBA Facebook
Per CMS, all provider inquiries should be directed to the Consolidated Call Center at (855) 696-0705.
Comply With MAC Request for Fingerprints Within 30 Days
CMS implemented the fingerprint-based background requirement on August 6, 2014, as discussed in the rule published on February 2, 2011. Fingerprint-based background checks are required for all individuals with a five percent or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or has submitted an initial enrollment application. Medicare Administrative Contractors (MACs) have begun sending letters to these providers and suppliers, listing all owners who are required to be fingerprinted. The letters are being mailed to the provider or supplier's correspondence address and the special payments address on file with Medicare.
Identified individuals have 30 days from the date of the letter to be fingerprinted. Failure to comply with the fingerprint requirements could result in denial of your Medicare enrollment application or revocation of your Medicare billing privileges. Visit Accurate Biometrics for fingerprinting procedures, to find a fingerprint collection site, and to ensure the fingerprint results are accurately submitted to the Federal Bureau of Investigation (FBI) and properly returned to CMS. For more information on this requirement, see MLN Matters® Special Edition Article #SE1427, 'Fingerprint-based Background Check Begins August 6, 2014.' If you have any questions, contact Accurate Biometrics at 866-361-9944.
Interactive Voice Response (IVR) Information
Part B providers may use the Interactive Voice Response (IVR) to request routine claims, beneficiary eligibility and payment information. The IVR is available 24 hours a day to obtain general information. Beneficiary eligibility and claim status information is available between 6 a.m. and 8 p.m. ET. With a touch-tone phone, you can obtain the latest information on your claims and other Medicare issues. Palmetto GBA will continue to ensure that routine inquiries regarding claim status and beneficiary eligibility are handled through the IVR, which will allow representatives to be available to handle more difficult or complex issues. You may access the Part B IVR at 855-696-0705.
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