Noridian updates medical records requirements
By HME News Staff
Updated 10:32 AM CDT, Mon October 7, 2024
WASHINGTON – In the event of a claim review, information contained directly in the contemporaneous medical record is the source required to justify payment, except as noted elsewhere for prescriptions, according to an update posted by Noridian Healthcare Solutions. The medical record is not limited to records from treating physician/practitioner offices but may include records from hospitals, nursing facilities, home health agencies and other health care professionals. Records from suppliers or health care professionals with a financial interest in the claim outcomes are not considered sufficient by themselves for determining that an item is reasonable and necessary. Noridian reminds DMEPOS suppliers that:
- Supplier-produced records, even if signed by the prescribing physician/practitioner, and attestation letters (e.g. letters of medical necessity) are deemed not to be part of a medical record for Medicare payment purposes.
- Templates and forms are subject to corroboration with information in the medical record.
- Medical information intended to demonstrate compliance with coverage criteria may be included on a prescription but must be corroborated by information contained in the medical record.
In addition to the general requirements discussed above, certain DMEPOS items may have specific documentation requirements. Details regarding these policy specific requirements are contained in the applicable LCD-related policy article.
For the full update, go here.
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