tci Part B Insider - 2015 Issue 43

Survive Probe & Educate F2F Review With These 4 Steps

You may have some hard choices ahead. Under Medicare’s new “Probe & Educate” medical review initiative for the face-to-face physician encounter, you could find yourself stuck on prepay medical review indefinitely. Smart certifying physicians and home health agencies will take these steps to increase their chances of defending against the P&E review and obtaining their reimbursement: 1. Know which elements the physician note requires. For a claim to pass medical review, a physician’s note containing three elements must be present: Proof that the visit occurred within the required timeframe, was related to the primary...

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