Person requesting consult must document it in chart

Why This Topic Matters

Consultation claims can be denied or recoded if the documentation requirements are not met, which can affect reimbursement and audit outcomes. Understanding the documentation expectations helps practices reduce risk when billing consultative services under Medicare.

Article Sections

1. Medicare consultation documentation requirement

   Introduces the Medicare consultation rule and the need for the requesting physician to document the request in the patient record. It also explains why this documentation is important for billing and audit review.

2. Practical steps for getting the request documented

   Describes a suggested process for creating a simple request form that can be shared with the referring physician. The section focuses on ways to support documentation capture without detailing billing outcomes.

3. CMS transmittal and manual update

   Identifies the CMS update that revised the Medicare Claims Processing Manual and provides the effective timing and manual reference. This section places the documentation guidance in the context of official Medicare policy changes.

4. Group practice consultations

   Discusses how consultation documentation is handled when records are shared within a group practice. It also covers the role of specialist expertise and internal workflow in assigning consultation requests.