Procedure Code Selection
Providers should choose billing and revenue codes carefully, based on medical necessity as supported in the documentation. If this responsibility is delegated, providers must ensure their staff understands coding principles, as providers are responsible for all claims submitted on their behalf. Contractual arrangements do not relieve physicians of this responsibility. Additionally, providers should conduct quality checks to ensure agreement with selected codes, and review coding manuals carefully to ensure proper code selection.
If Medicare will suspect the reporting code then it will ask Medical records to verify the claim. And may be audit will happen.
Documentation
Medicare strives to minimize its documentation requirements for most services and place no additional paperwork burden on physicians. Sometimes, as with Certificates of Medical Necessity, extra documentation is required. Many situations may cause Medicare to request documentation for services or items furnished. Physicians should document the service or item at or as close as possible to the time it was furnished, since late entries increase the likelihood of inaccuracies, and may raise questions regarding the cause of the delay.
Honest mistakes may happen when submitting claims to Medicare. Physicians who make unintentional coding errors do not commit fraud, and CMS does not impose fines for unintentional coding errors. However, when overpayments are identified, CMS is required by law to recover them.
