Complying with medical record documentation requirements

A fact sheet was developed by the Medicare Learning Network® (MLN), in conjunction with the Comprehensive Error Rate Testing (CERT) Part A and Part B (A/B) and DME MAC Outreach & Education Task Forces, to provide nationally consistent education on topics of interest to health care professionals. It is designed to help providers understand how to provide accurate and supportive medical record documentation. 

This fact sheet discusses the following:

• Third-party additional documentation requests
• Insufficient documentation errors

1. Vertebral augmentation procedures
2. Physical therapy services
3. Evaluation and management services
4. DME
5. Computed tomography scans
6. Resources

First Coast encourages providers to review MLN Matters fact sheet to learn more about reducing medical documentation errors. 

Reference 

• MLN ICN 909160