tci Medicare Compliance & Reimbursement - 2006 Issue 20

CONSULTS: CMS' New Consult Guidelines Still Confuse Providers

Providers need to make sure they have the written request in their files.Most consults are medically necessary--they just have documentation problems, says one top CMS official.But providers won't get into trouble if they bill a consult and it turns out that the physician who requested the consult didn't have the request documented in his or her files, confirms William Rogers, director of the Physician Regulatory Issues Team at the Centers for Medicare & Medicaid Services. The requesting physician is still required to document that request, but it's not the consultant's responsibility to verify that documentation in the...

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