TPE review verifies that services are performed and billed appropriately based on current guidelines, including but not limited to LCDs, local coverage articles, NCDs, IOMs, and the Social Security Act (SSA).
When a provider determines that a Medicare overpayment exists, the following steps must occur.
Complete the Return of Monies Voluntary Refund Form
In order to ensure the MSP refund is properly processed, a copy of the other insurer’s EOB and/or payment information (i.e., a copy of the check) is required to calculate the Medicare Secondary payment. When the Medicare Secondary payment is calculated, it will determine if the refund amount is correct or there is an additional balance due.
First Coast accepts medical records via:
A therapist may bill for more than one therapy service that was furnished within the same 15-minute time period when "supervised modalities" have been defined by the American Medical Association (AMA) as “untimed and unattended and not requiring the presence of the therapist” (CPT codes 97010 to 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact.
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No, however OPTs and CORFs are different provider types and submit claims on different types of bills. In addition, they are not part of an outpatient hospital therapy department.
The Initial Notification Letter includes a documentation checklist to help providers prepare documentation for submission. The documentation checklist can also be found under targeted probe and educate review topics and schedule of review.
Once an ADR is received, a provider should do the following:
Beginning with dates of service on and after January 1, 2011:
(Additionally, when the physician decides the patient should be in observation without prompting by the utilization review (UR) committee or case management and prior to the discharge of the patient and submission of the claim.)
No. When a physician orders a patient to be placed under observation, the patient's status is outpatient. The purpose of observation is to determine the need for further treatment or for inpatient admission.
