Study Essay example

650 Words Mar 15th, 2013 3 Pages
Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the Beneficiary Notices Initiative to alert the Medicare beneficiary prior to rendering the service. The Medicare beneficiary is notified via the Advance Beneficiary Notice (ABN) (see page 235 in Appendix B).

The Medicare beneficiary may choose to complete the ABN and provide
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Therefore, these codes should be used to identify stable angina and documentation should support that diagnosis.

Further, around $20,790.00 has been written off due to ABNs not being issued for this cardiac rehabilitation service.

Questions

a. What went wrong in the revenue cycle?
There was no revenue. Like it is listed above after auditing the remittance advice logs and medical records, the Revenue Cycle Team has determined that medical necessity is not being met for code 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]) and around $20,790.00 was written off due to ABN’s (Advance Beneficiary Notice) not being issued. b. How would you suggest rectifying this issue?
“This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the

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