2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing (On-Demand) | November 2021-11 - Key to Economic Sucess Perfecting Proper Documentation Medical Necessity

11 - Key to Economic Sucess Perfecting Proper Documentation Medical Necessity_Mueller

Pdf Summary

In this document, Kathleen A Mueller discusses the importance of proper documentation for medical necessity in order to achieve economic success. She highlights that without medical necessity, services won't be preauthorized, won't get paid, and previous payments may be recouped by payers. Mueller identifies the top medical necessity areas of payer focus, which include diagnostic EGD, infusion services, hemorrhoid treatments, multiple endoscopy, pathology and special stains, screening versus diagnostic colonoscopy, and evaluation and management services.<br /><br />Mueller provides specific tips for documenting diagnostic EGDs, emphasizing the need for specific documentation in the patient's medical record regarding pertinent history and symptoms. She also presents the medical necessity criteria for diagnostic EGDs set by payers such as Anthem, Aetna, Tufts, Humana, and UHC.<br /><br />The document also discusses the documentation requirements for infusion services, evaluation and management services, and endoscopic procedures. Mueller notes that detailed and accurate documentation is essential for billing and ensuring appropriate reimbursement. She provides billing tips for various endoscopic procedures, emphasizing the importance of specifying locations, methods used, and indications for each procedure.<br /><br />The document concludes with some medical necessity pearls, including the necessity of listing symptoms requiring diagnostic evaluation, documenting all pertinent comorbidities, staying updated on payer policies, justifying the level of visit through medical decision making or time, and ensuring timely completion and signing of documentation.<br /><br />Overall, Mueller emphasizes the significant role that proper documentation plays in obtaining preauthorization, receiving payment, and avoiding recoupment of payments. She provides valuable insights and tips for healthcare providers to improve their documentation practices for medical necessity.

Keywords

proper documentation

medical necessity

payer focus

diagnostic EGD

infusion services

endoscopy

evaluation and management services

billing

reimbursement

healthcare providers