4 ways to protect against increase in post-pay denials for prothrombin time

Why This Topic Matters

Prothrombin time is a routine service that can still face denials when documentation is incomplete or when medical necessity is not clearly supported in the record. The article helps readers understand the scope of the review trend and the general compliance areas that practices should pay attention to.

Article Sections

1. Post-payment review trends and CERT findings

   Introduces the rise in Medicare post-payment scrutiny and the broader audit themes reflected in CERT reports. It also identifies the contractors and regional focus areas mentioned in the article.

2. Written protocols for prothrombin time

   Discusses the role of standing protocols and the need for documentation that can support claims when review requests are made. The section focuses on process and recordkeeping concerns.

3. Supplemental documentation and medical necessity

   Covers the importance of preserving documentation tied to the start of ongoing monitoring services. It addresses record retention and support for continued testing.

4. Documentation when non-physician practitioners are involved

   Explains documentation concerns that arise when services are carried out under non-physician practitioner workflows. The section highlights the need for clear plans of care and supporting records.

5. Evaluation and management services billed with prothrombin time

   Reviews the relationship between prothrombin time billing and separately reported office/outpatient evaluation and management services. It focuses on the documentation context discussed in the article.