May 14, 2010
In the past six month, two Medicare carriers - Trailblazer Health Enterprises and WPS Health Insurance preformed high-dollar claim reviews on drug administration codes and medications. These claim reviews targeted key areas such as high-dollar drugs (i.e.,infliximab and rituximab), service payments such as drug administration codes and documentation of services billed.
Below is a list of the common errors found:
- Physician's name and dates missing or not legible in the medical record
- Documentation of total dosage of the drug did not match what was billed out
- The number of drug vials and/or units per vial was missing or not legible
- Total units provided to the patient not specified by each date of service, but was listed by range of dates of service (i.e., 3/1/09 - 3/30/09, 2000-4000 units)
- No documentation of drug wastage
- Inaccurate start and stop time of the medication
- Office visits that do not support medical necessity
In an effort to reduce claim denials and reduced payments the American College of Rheumatology would like to take the opportunity to remind our members that if something is not documented it is not billable. Accurate and timely documenting is the combination needed to correctly record the patient's visit. This will always put you on the right path for coding properly for the service that is provided for your patient. If you have further questions about this matter contact Melesia Tillman, CPC at (404) 633-3777 ext. 820 or via email at email@example.com.