NGS -Medicare Medical Review Results, Provider Compliance


NATIONAL GOVERNMENT SERVICES (NGS) – MEDICARE MEDICAL REVIEW RESULTS

NGS conducted prepayment reviews on claims during April 2017 through June 2017 for CPT codes 99214 and 99215.

During the review timeframe, an average of 34% of the claims were denied or reduced for the following reasons:

  • Medical decision making did not support the level of service billed

  • Illegible documentation

  • Missing and/or incomplete documentation

  • The rendering physician on the claim was not the physician who rendered the service

  • No response to request for documentation

  • Missing or illegible provider signature on documentation

  • The documentation lacked the beneficiary identification

NGS also conducted a prepayment review on claims during the same time period for CPT codes 99223 and 99233.

During the review timeframe, an average of 64% of the claims were denied or reduced for the following reasons:

  • The majority of services were re-coded to a lower level E&M, because the record lacked documentation supporting the key components

  • Missing, incomplete and/or illegible documentation

  • No response to request for documentation

  • The rendering physician on the claim was not the physician who rendered the service

  • The documentation lacked the beneficiary identification

The results of these Medical Reviews are located on NGS’s website under their Medical Review Focus Area section at www.ngsmedicare.com, which can be found under the Medical Policy & Review tab.

PROVIDER COMPLIANCE

As a reminder, the Centers for Medicare and Medicaid Services (CMS) has implemented a series of videos from the Medicare Learning Network (MLN) to help providers of all types improve in areas identified with a high degree of noncompliance.

These videos are referred to as Provider Minute Videos as the recordings last anywhere from one to three minutes and are an educational resource to the provider community.

Recently, CMS republished the video for Preventive Services.

To locate this video and more, please access the Provider Compliance section of CMS’s website at:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html

and click on: CMS Provider Minute YouTube playlist

For Compliance questions, please contact Becky Amann at 716-389-3202 or beckya@pracfirst.com

275 Northpointe Pkwy, Suite 50

Amherst, NY 14228

866.234.5017 (Toll-free)

info@pracfirst.com

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