To avoid appeal
Comply with requests for supporting documentation. Failure to comply with the request will result in a denial.
* The process whereby a contractor requests additional documentation after claim receipt is known as “development”. When a coverage or coding determination cannot be made based upon the information on the claim and its attachments (e.g., due to a medical review of the service/claim), contractors may solicit for more information from the provider by issuing an Additional Documentation Request (ADR). Highmark Medicare Services will specify in the development letter or ADR the piece(s) of documentation needed to make the coverage or coding determination.
* For responses to development that are received within the 45-day timeframe, Highmark Medicare Services will complete the review and notify the provider and beneficiary, if indicated, of the claim determination within 60 days of receiving all the requested documentation. For record or documentation requests where no timely response was received, Highmark Medicare Services will indicate that the denial was made without reviewing the medical record because the requested records were not received or were not received timely.
The supporting documentation must include the rendering physician’s signature. Failure to provide a valid signature will result in a denial.
* Medicare contractors require a legible identifier for services provided or ordered.
* The only acceptable method of documenting the provider signature is by written or an electronic signature.
* Stamp signatures are not acceptable to sign an order or other medical record documentation for medical review purposes.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, ...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...