… CMS has updated the Program Integrity Manual to clarify that contractors must consider all documentation during a medical review, to include information such as physical and occupational therapy evaluations, physicians’ letters, other written physician evaluations, or any document that provides relevant information about a patient’s clinical condition
Categories: Medical Condition… CMS has updated the Program Integrity Manual to clarify that contractors must consider all documentation during a medical review, to include information such as physical and occupational therapy evaluations, physicians’ letters, other written physician evaluations, or any document that provides relevant information about a patient’s clinical condition. When documentation does not support information in physician progress notes, the physician’s notes will be the determining factor during the review. However, if documentation is provided in place of physician progress notes, contractors will determine whether the documentation is sufficient to justify coverage. If it is not, the claim will be denied, CMS said. To read CMS’s clarification of the Program Integrity Manual, go to www.cms.hhs.gov/manuals/pm_trans/R100PI.pdf.