Service-specific reviews
First Coast performs data analysis on a regular basis on all services billed to Medicare to identify services that are frequently not billed and coded correctly per Medicare guidelines.
Post-pay service-specific reviews are performed based on results of a widespread data analysis that focuses on specific topics. If you bill Medicare for these services, you may receive an additional development request (ADR) letter asking for documentation. This allows First Coast to validate that you have billed the services correctly according to Medicare guidelines. Once the ADR is received, you will have 45 days to respond to the request with the supporting medical record documentation. The review will be completed within 60 days of receipt of the documentation. When the review is completed, you will be notified of the results.
Medical review Part A
| Service-specific review topic | Review status | Documentation checklist | Results summary (Overall results to be added as reviews are completed) |
|---|---|---|---|
| Therapeutic services one or more areas (CPT 97110) | Inactive | Part A therapy and rehabilitation checklist | Therapeutic services (CPT 97110) results |
| Therapeutic activities, direct patient contact (CPT 97530) | Inactive | Part A therapy and rehabilitation checklist | Therapeutic services (CPT 97530) results |
| Hyperbaric oxygen therapy G0277 | Inactive | Hyperbaric oxygen (HBO) therapy documentation checklist | Hyperbaric oxygen therapy G0277 summary |
Medical review Part B
| Service-specific review topic | Review status | Documentation checklist | Results summary |
|---|---|---|---|
| Rehabilitation services: Outpatient physical and occupational therapy (CPT 97110) | Inactive | Rehabilitation services checklist | Outpatient rehabilitation services summary |
| Ambulance services (CPT A0425-A0428) | Inactive | Ambulance services documentation checklist | Ambulance services summary |
| Drugs and biologicals J0178 Eylea, J0897 Prolia, J2778 Lucentis, J9217 Lupron (Leuprolide) | Inactive | Drugs & biologicals checklist | Drugs & biologicals summary |
| Hyperbaric oxygen | Inactive | Hyperbaric oxygen (HBO) therapy documentation checklist | Hyperbaric oxygen therapy summary |
| Clinical labs (CPT codes 80305-80307 and G0480-G0483) | Inactive | Clinical labs checklist | Clinical labs summary |
| Clinical labs (CPT code 86001 | Inactive | Clinical labs checklist | Clinical labs summary |
| Psychotherapy (CPT codes 90832 – 90839) | Inactive | Psychotherapy services checklist | Psychotherapy services summary |