Medical Review

Edit Reason Code: 5ANKP
Bill Type = 81X or 82X

Overview

The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a claim is randomly selected for review, the provider will receive an ADR letter. We must receive the medical records necessary to support the billed services within 45 days of the date of the ADR letter. Failure to submit the requested documentation in a timely manner may result in denial of the billed service. All documentation must be legible and authenticated by an acceptable handwritten or electronic signature. We will issue results upon completion of the post-payment review and offer education as needed.

Documentation Requirements

  1. Hospice election form                  
  2. Hospice certification/recertification
  3. Hospice initial admission assessment documentation
  4. Hospice plan of care     
  5. Documentation for all services provided, can include but is not  limited to: nursing, therapy, social services, volunteer
  6. Interdisciplinary team documentation                                     
  7. Revocation of hospice election, if appropriate                        
  8. Documentation of any change in hospice status                                                 
  9. Hospice discharge documentation, if appropriate                          
  10. Please include the medical records/documentation for the previous 30 days from the claim's billed dates of service                    
  11. Documentation for episodes with start of care beginning or after 1/1/2011, the certifying physician must document a face-to-face encounter with the patient as described in the CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Hospice; Section 20.1, “Timing and Content of Certification.”

Providers note: If there is an ABN on file, please submit the ABN with the above requested documentation.
      

Related Content

Posted 8/25/2020

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.