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Cigna Medicare Tips

 

 Top 3 reasons claims are denied or downcoded.

  1. Past family and social history is not fully documented.
  2. Review of Systems is not fully documented
  3. Documentation of medical decision making is not fully documented.

AMA definition of legibility - three of the physician's peers must be able to decipher the notes.


When is Time Important?

Psychiatry & Physical Therapy- Need to document START and FINISH time. Total Time is not sufficient. With Physical Therapy the same code is billed in 15-minute increments.


Medicare Questions and Answers:

Questions:

Answers

How often do you need to have MCE signature form signed? Only if rescinded. Only if Medigap insurance changes.
How long are claims held? Electronic Claims - 13 days held before check cut.

Paper Claims - 26 days held before check cut.

How far back do they retain records? Current Year, Preceding Year and Last Quarter. 
 
 
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