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.
- 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?"
- If I document the most pertinent systems under the ROS, is it okay to say, "All other systems reviewed and are negative?"
- 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?
- 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?
- How do your auditors tell the difference between and EPF exam and a detailed exam using the 1995 E/M guidelines?
- When using the 1995 guidelines for the physical exam, can I say “unremarkable” if an organ system has normal findings?
- Can I say “non-contributory” when completing the FH if the information obtained is not germane to the clinical problems at hand?
- What exactly is meant by prescription drug management in the table of risk? Do I have to add, stop or adjust a drug?
- Can I use a questionnaire when completing the ROS and PFSH and if so, what documentation is required?
- 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
Medicare Providers of Alabama
www.cahabagba.com
(866) 539-5598
Email your questions for this carrier by clicking HERE.
Alaska
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Exmail your questions to Linda.Windley@Noridian.com.
Arizona
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Email your questions to this carrier by clicking HERE.
Arkansas
Arkansas Medicare Services
www.arkmedicare.com/
(800) 633-4227
California (Northern)
National Heritage Insurance Co.
www.medicarenhic.com/index.shtml
(877) 591-1587
California (Southern)
National Heritage Insurance Co.
www.medicarenhic.com/index.shtml
(866) 502-9054
Colorado
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Connecticut
First Coast Service Options, Inc.
www.connecticutmedicare.com
(866) 419-9455
Delaware
Trailblazer Health Enterprises
www.trailblazerhealth.com/
(888) 205-6833
District of Columbia
Trailblazer Health Enterprises
www.trailblazerhealth.com/
(888) 205-6833
Florida
First Coast Service Options
www.floridamedicare.com/
(877) 602-8816
Email your questions to this carrier by clicking HERE.
Georgia
Georgia Medicare Services
www.cahabagba.com
(877) 567-7271
Email your questions to this carrier by clicking HERE.
Hawaii
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Idaho
Cigna Healthcare
www.cignamedicare.com/
(866) 502-9051
Illinois
Wisconsin Physicians Service Insurance Corporation
www.wpsmedicare.com
(877) 908-9499
Indiana
AdminaStar Federal
www.adminastar.com
(866) 250-5665
Iowa
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Kansas
Kansas Medicare
www.kansasmedicare.com
(877) 567-7270
Kentucky
AdminaStar Federal
www.adminastar.com
(866) 250-5665
Louisiana
Pinnacle Medicare Services
www.lamedicare.com/
(866) 567-8419
Maine
National Heritage Insurance Co.
www.medicarenhic.com/ne_prov/index.shtml
(877) 567-3129
Maryland
Trailblazer Health Enterprises
www.trailblazerhealth.com/
(888) 539-5591
Massachusetts
National Heritage Insurance Co.
www.medicarenhic.com/ne_prov/index.shtml
(877) 567-3130
Michigan
Wisconsin Physicians Service Insurance Corporation
www.wpsmedicare.com
(877) 567-7201
Minnesota
Wisconsin Physicians Service Insurance Corporation
www.wpsmedicare.com
(877) 908-8470
Mississippi
Mississippi Medicare Services
www.cahabagba.com
(866) 419-9454
Email your questions to this carrier by clicking HERE.
Missouri (Eastern)
Missouri Medicare Services
www.momedicare.com
(866) 736-0799
Missouri (Northwest)
Northwest Missouri Medicare
www.kansasmedicare.com
(866) 839-2442
Montana
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Nebraska
Nebraska Medicare
www.kansasmedicare.com
(866) 839-2438
Nevada
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
New Hampshire
National Heritage Insurance Co.
www.medicarenhic.com/ne_prov/index.shtml
(866) 539-5595
New Jersey
Empire Medicare Services
www.empiremedicare.com/
(877) 567-9235
New Mexico
Oklahoma/New Mexico Medicare Services
www.oknmmedicare.com/
(866) 280-6520
New York
Empire Medicare Services
www.empiremedicare.com/
(877) 869-6504
North Carolina
Cigna Healthcare
www.cignamedicare.com/
(866) 238-9651
North Dakota
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Ohio
Palmetto GBA
www.pgba.com
(877) 567-9232
Oklahoma
Oklahoma/New Mexico Medicare Services
www.oknmmedicare.com/
(866) 280-6520
Oregon
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Email your questions to: Lori.Weber@Noridian.com
Pennsylvania
Highmark Medicare Services
www.highmarkmedicareservices.com
(866) 488-0548
Rhode Island
Rhode Island Medicare Services
www.rimedicare.org
(866) 801-5304
South Carolina
Palmetto GBA
www.pgba.com/
(866) 238-9654
South Dakota
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Tennessee
Cigna Healthcare
www.cignamedicare.com/
(866) 502-9056
Texas
Trailblazer Health Enterprises
www.trailblazerhealth.com/
(866) 211-5708
Utah
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Vermont
National Heritage Insurance Co.
www.medicarenhic.com/ne_prov/index.shtml
(866) 539-5595
Virginia
Trailblazer Health Enterprises
www.trailblazerhealth.com/
(866) 717-0010
Washington
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
Email your questios to: Tammy.Ewers@Noridian.com
West Virginia
Palmetto GBA
www.pgba.com
(877) 567-9232
Wisconsin
Wisconsin Physicians Service Insurance Corporation
www.wpsmedicare.com
(877) 567-7176
Wyoming
Noridian Administrative Services
www.noridianmedicare.com
(877) 908-8431
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