As you know, effective July 1, 2013 Functional Reporting applies to all claims furnished under the Medicare Part B outpatient therapy benefit and to Physical Therapy (PT), Occupational Therapy (OT), and Speech- Language Pathology (SLP) services furnished under the Comprehensive Outpatient Rehabilitation Facility (CORF) benefit CMS offers a Quick Reference Guide that summarizes this requirement.
Here is the link to access:
CGS Ask the Contractor (ACT) session- Top Denial Reasons for medical Review January-March 2013.
ACT was held on August 14, 2013. The replay is available until August 20, 2014 by calling 1-888-203-1112, Pass code 8978890. The ACT discussed CGS News article of June 28, 2013 that listed top denials codes, here is the link:
5DOWN – Medical Review Downcode
5D504/5H504 – Information provided does not support the medical necessity for this service
5D501/5H501 – Billed in error 5D507/5H507 – SNF MDS is not in the National Repository
5H508 – Benefits exhausted on SNF claim for services subject to benefit period determination
56900 – Medical records not received 5D171/5H171 – The requirements for a short stay are not met
**** CGS stressed the importance of internal audits as an effective tool to save time and money when dealing with ADRs ****
Call to hear about Premier’s “Audit Score Card” which gives an interdisciplinary documentation report card!