Medical Review

Service Specific Post Payment Review of Floweramnioflo, 0.1 CC – CPT Q4177

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service specific post payment review of:

  • Q4177 Floweramnioflo, 0.1 cc

The primary focus of these audits will be to determine whether the medical necessity of the services billed is at the correct code per Medicare guidelines.

NGS has randomly selected claims billed for the services mentioned in J6 for Part B providers in the states of Illinois, Minnesota and Wisconsin.

If a claim is selected for review, the provider will receive an ADR letter. Providers with claims selected for review must submit the requested documentation within 45 days of the date of the ADR letter. Failure to submit the requested documentation in a timely manner may result in a denial of the billed services.

It is important to submit all documentation which supports the medical necessity of the mentioned services. The medical record must be legible and the name of the beneficiary, the date of service, and the signature of the billing provider clearly identified. Please ensure all documentation to support medical necessity of the billed service is submitted for review.

Documentation Requirements

  • A copy of any mandatory ABN of non-coverage to the beneficiary
  • Physician/nonphysician practitioner’s office and progress notes
  • History and physical examination notes with relevant medical history
  • Procedure and operative reports
  • Pertinent diagnostic reports
  • Orders
  • Documentation to support the service was performed
  • Documentation to support the need for skin substitute application and the product used
  • Documentation of product wastage and reason
  • Any conservative treatment given and response
  • All treatment notes including wound description at baseline, progression of wound and responses
  • Documentation to support underlying conditions have been treated and resolved
  • Documentation of smoking history and treatment for smoking cessation (if applicable) and outcome
  • Any additional documentation verifying medical necessity
  • Legible signature/sample signature log/signature key/signature page, etc. to affirm the provider signature
  • Providers/suppliers must pay the cost of providing this documentation; it cannot be billed to CMS or the MAC program.
  • The CMS encourages providers/suppliers to respond quickly.
  • Please do not include Powers of Attorney, Living Wills, or Correspondence.
  • During this review period and at all times, in order to receive payment, providers/suppliers must continue to submit claims for all services performed on a beneficiary.

Related Content

Posted 1/25/2021

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex

Visit our Contact Us page for other methods of submission

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.

Helpful Resources

Targeted Probe and Educate Manual

The preferred method to submit Medical Records is NGSConnex:

Visit our Contact Us page for other methods of submission.