tci Medicare Compliance & Reimbursement - 2006 Issue 32

ED CODING: Check Physician Notes Before Appealing Critical Care Claims

If you don't meet these documentation requirements, you will not win appeal.When you receive a denial from a payer for critical care services, you should not just give up on payment ...quot; nor should you automatically start the appeals process. Look back at the ED physician's op notes for the encounter, and then decide whether to appeal.Benefit: At times, insurers deny legitimate critical care claims. However, you may also find that the denial was correct, in which case appealing is a waste of time and resources.When a physician provides services that might be considered critical care...

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