Coding and Billing

Medicare Provider Compliance: What ODs Need to Know

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

June 5, 2019

Medicare provides helpful information for providers. Within the Medicare Learning Network is a page titled “Provider Compliance.”1 This page is divided into Compliance-Related Resources and Fraud and Abuse-Related Resources. We are using this article to highlight some of this information for you.

Under the Compliance-Related Resources, if you look under the subsection of Provider Compliance Educational Products, there are PDFs on topics, such as Complying With Medical Record Documentation Requirements (ICN 909160), that are worth your read.

Under this same section is a PDF on the topic of Complying With Medicare Signature Requirements. This answers the questions of: do I need to sign my records if I am the only doctor in the practice, what is required for a valid signature, what should I do if I did not sign an order or medical record, and what are the guidelines for using an electronic signature?

Under the Compliance-Related Resources are helpful short YouTube videos. HERE is a video that you should find helpful on duplicate claims.

Telehealth is a current “hot topic” and, as you would expect, Medicare provides guidance. You can find that guidance HERE.

Why do you need to know this information? Because when you are “in compliance” you are doing things correctly when either coding or billing. When you are “out of compliance,” the claim will be denied and no payment will occur.

References
i. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html

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