What medical records are necessary?
- Ask yourself these questions:
- Does the item fit a Medicare benefit category?
- Is the item statutorily excluded from coverage?
- Is the item medically reasonable and necessary?
- Is there documentation to support the item was provided?
- Is there documentation to support frequency/quantity?
- Is there documentation to support current medical need?
- Is the item coded and billed correctly?
- Do the medical records on hand support coverage requirements listed in any related LCD or NCD?
- Ensure the medical records answer those questions by containing:
- Patient’s diagnosis
- Duration of patients condition
- Clinical course
- Nature and extent of functional limitation
- Prognosis
- Current need/use of the item
- Frequency and/or quantity prescribed
- Etc