decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2000 / B-00-74
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Article Overview
This HCFA Program Memorandum outlines carrier instructions for supporting a medical review project related to evaluation and management services. It explains the scope of records to be made available, the participating carrier groups, the physician specialties involved, and the administrative steps needed to support vignette development and related review activities. The article is relevant to Medicare carrier operations, medical review staff, and coding professionals working with E/M documentation guidance.
Why This Topic Matters
It documents a Medicare administrative process tied to E/M documentation guideline development and shows which claims populations and specialties were targeted for review. Readers in carrier operations, compliance, and coding policy can use it to understand the project’s scope and timing.
Article Sections
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Program Memorandum and Project Background
Introduces the memorandum, the issuing organizations, the transmittal information, and the overall purpose of the request.
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Claims and Medical Record Retrieval Instructions
Describes the carrier workload, the record retrieval process, and the administrative handling of selected claims and associated medical records.
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Vignette Development and Review Activities
Summarizes the planned development of draft vignettes and the review process involving selected carriers and HCFA staff.
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Educational Materials and Best Practices Compilation
Covers the collection of carrier educational materials and review protocols for consolidation into future training resources.
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Effective Date and Implementation
Provides the timing information for the memorandum’s effectiveness, implementation, and retirement.
What You Will Learn
- The administrative purpose of the memorandum
- How the medical record retrieval project was organized
- Which broad provider specialties were included in the project
- How draft review materials were to be developed and examined
- The effective and implementation timing for the memorandum
Who Should Read This
- Medicare carrier staff
- Medical review personnel
- Coding and compliance professionals
- Health care administrators
- Policy and operations teams
Code Ranges Discussed
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