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Medicare carriers
 

 

Get it in Writing!

The E/M guidelines are ambiguous on several key points of documentation. There are several gray areas which may affect how your documentation is audited by your particular Medicare carrier. We recommend that you cut and paste the questions below into an email and send them to your carrier. When you get a reply, please forward a copy to Dr. Jensen at pjensen@emuniversity.com so we can post the answers on our site.

  1. The 1997 E/M guidelines allow you to complete an EXTENDED HPI by commenting on the status of three or more “chronic or inactive problems." Can we also use this rule when completing the HPI using the 1995 E/M guidelines (Or do we have to use FOUR comorbidities as outlined in the official 1995 rules)? Also, no mention is made of using "chronic or inactive problems" to complete a BRIEF HPI. Is it correct to assume that if you comment on one to two problems that you can qualify for a BRIEF HPI. Can we use this for both the 1997 and the 1995 E/M guidlines? Finally, what is meant by "chronic or inactive problems." If we are writing a progress note for a patient in the hospital, can we use the problems we are addressing from day to day to care for the patient--even though they are technically neither "chronic" nor "inactive?"
  2. If I document the most pertinent systems under the ROS, is it okay to say, "All other systems reviewed and are negative?"
  3. Is it okay for me to refer to an earlier note's PFSH and ROS when I see the patient in the office?  If so, what do I have to document?
  4. What is required for a comprehensive physical exam using the 1995 E/M guidelines?  Do you have to have eight or more organ systems or can you use the body areas?
  5. How do your auditors tell the difference between and EPF exam and a detailed exam using the 1995 E/M guidelines?
  6. When using the 1995 guidelines for the physical exam, can I say “unremarkable” if an organ system has normal findings?
  7. Can I say “non-contributory” when completing the FH if the information obtained is not germane to the clinical problems at hand?
  8. What exactly is meant by prescription drug management in the table of risk?  Do I have to add, stop or adjust a drug?
  9. Can I use a questionnaire when completing the ROS and PFSH and if so, what documentation is required?
  10. Do your auditors use a point system to quantify the MDM and, if so, can you provide me with the rules and your auditing form so I can incorporate the rules correctly into my compliance plan?
 

Alabama


Cahaba GBA, LLC
877-567-7271
www.cahabagba.com

Alaska


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

American Samoa


Palmetto GBA
866-931-3901
www.palmettogba.com

Arizona


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

 

Arkansas


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

California


Palmetto GBA
866-931-3901
www.palmettogba.com

Colorado


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

Connecticut


National Government Services, Inc.
888 379-3807
www.ngsmedicare.com

District of Columbia


Novitas Solutions, Inc.
1-877-235-8073
www.novitas-solutions.com

Delaware


Novitas Solutions, Inc.
1-877-235-8073
www.novitas-solutions.com

Florida


First Coast Service Options
866-454-9007
www.fcso.com

Georgia


Cahaba GBA, LLC
877-567-7271
www.cahabagba.com

Guam


Palmetto GBA
866-931-3901
www.palmettogba.com

Hawaii


Palmetto GBA
866-931-3901
www.palmettogba.com

Idaho


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

Illinois


Wisconsin Physicians Service
877-908-8476
www.wpsmedicare.com

Indiana


Wisconsin Physicians Service
855-280-5484
www.wpsmedicare.com

Iowa


Wisconsin Physicians Service
866-503-7664
www.wpsmedicare.com

Kansas


Wisconsin Physicians Service
866-503-7664
www.wpsmedicare.com

Kentucky


CGS Administrators LLC
866.276.9558
www.cgsmedicare.com

Louisiana


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

Maine


NHIC, Corp.
888-300-9612
www.medicarenhic.com

Maryland


Novitas Solutions, Inc.
1-877-235-8073
www.novitas-solutions.com

Massachusetts


NHIC, Corp.
888-300-9612
www.medicarenhic.com

Michigan


Wisconsin Physicians Service
855-280-5484
www.wpsmedicare.com

Minnesota


Wisconsin Physicians Service
866-564-0315
www.wpsmedicare.com

Mississippi


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

Missouri


Wisconsin Physicians Service
866-503-7664
www.wpsmedicare.com

Montana


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

Nebraska


Wisconsin Physicians Service
866-503-7664
www.wpsmedicare.com

Nevada


Palmetto GBA
866-931-3901
www.palmettogba.com

New Hampshire


NHIC, Corp.
888-300-9612
www.medicarenhic.com

New Jersey


Novitas Solutions, Inc.
1-877-235-8073
www.novitas-solutions.com

New Mexico


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

New York


National Government Services, Inc.
888 379-3807
www.ngsmedicare.com

North Carolina


Palmetto GBA
866-830-3043
www.palmettogba.com

North Dakota


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com/

Ohio


CGS Administrators LLC
866.276.9558
www.cgsmedicare.com

Oklahoma


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

Oregon


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

Pennsylvania


Novitas Solutions, Inc.
1-877-235-8073
www.novitas-solutions.com

Puerto Rico


First Coast Service Options
877-715-1921
www.fcso.com

Rhode Island


NHIC, Corp.
877-258-4442
www.medicarenhic.com

South Carolina


Palmetto GBA
866-830-3043
www.palmettogba.com

South Dakota


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

Tennessee


Cahaba GBA
877-567-7271
www.cignamedicare.com

Texas


Novitas Solutions, Inc.
855-252-8782 (Option 4)
www.novitas-solutions.com

U.S. Virgin Islands


First Coast Service Options
877-715-1921
www.fcso.com

Utah


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

Vermont


NHIC, Corp.
888-300-9612
www.medicarenhic.com

Virginia


Palmetto GBA
866-830-3043
www.palmettogba.com

Washington


Noridian Administrative Services
888-608-8816
www.noridianmedicare.com

West Virginia


Palmetto GBA
866-830-3043
www.palmettogba.com

Wisconsin


Wisconsin Physicians Service
877-908-8476
www.wpsmedicare.com


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