decisionhealth Newsletters, Part B News - 2005 Issue 2 (February)
Audits: New guidance on documentation could help you survive a carrier audit
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Article Overview
This article explains recent CMS guidance aimed at carrier auditors and discusses the kinds of documentation that may support medical necessity in pre- and post-payment review situations. It is relevant for physicians, practice managers, coders, compliance staff, and billing teams who want to understand how documentation from the treating physician and related records may be evaluated during an audit.
Why This Topic Matters
It helps readers understand the broader documentation issues that can affect audit outcomes and claim support when records are reviewed by carriers.
What You Will Learn
- What types of documentation CMS says may be considered in audit review
- How documentation timing and authorship may be viewed in a carrier audit
- Why supporting records beyond the progress note can matter
- How adjunct records may be used to help substantiate a claim
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance staff
- Practice managers
- Healthcare attorneys
- Consultants
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