The Centers for Medicare and Medicaid Services (CMS) has mandated that medical necessity be documented for Medicare patients. When ordering tests, providers need to document all diagnoses and the reasons that the tests are ordered to insure appropriate reimbursement. Ordering tests just because someone is having surgery, or to rule something out, isnít sufficient for Medicare. The tests will still be done, but the hospital wonít be reimbursed.
Coders will contact you for more information, if it isnít provided when the tests are ordered either by phone or using a clarification request form. Quick reference sheets on high volume tests will be provided to your offices in future to show examples of acceptable documentation. Your cooperation and help is appreciated.