More Fun by a Payer
by Cheryl Nash
Humana has started issuing letters requesting medical records for an audit of their Medicare Advantage Plan members. We have received information of from two providers in phlebology practices that have received the same request – in different states. This appears to be a random audit to compare to current medical necessity and correct coding guidelines.
If a request of this nature is received, all records should be pulled and copied, placed in chronological order, and checked for completeness prior to submitting. Submission will need to be timely as there is typically a deadline for compliance.
We recommend doing an internal audit of your Humana Medicare patient’s charts to ensure your records are complete. If there is something missing but the information is captured on a different form in the chart, you can provide an addendum to something like the History and Physical. The addendum needs to be clearly dated with the current date and signed. However, the information should be present in the chart already and cannot be created whole cloth into the chart.
Humana’s Medicare Advantage plans follow your local LCD policies; these can be found through the following link;http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx
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