April 12, 2012
Probe Medical Review of Permanent Cardiac Pacemaker Implant (DRG 243 and DRG 244)
The J15 A Medical Review department will perform a service-specific probe review on permanent cardiac pacemaker implant. This review will be performed in Kentucky and Ohio and is based on increased medical review funding and recent CERT data at the national level. The medical review of claims will be performed on a sample of 100 claims per state for DRG 243 and DRG 244.
Providers who receive an Additional Documentation Request (ADR) must submit the requested medical record information within 30 days to:
CGS
J15 Part A Medical Review
Mail Code: AG-256
P.O. Box 100140
Columbia, SC 29202-3140
Please mail the medical records to the following address if you are using overnight service:
CGS
J15 Part A Medical Review
Mail Code: AG-256
2300 Springdale Drive, Building One
Camden, SC 29020
Or fax to (803) 462-2592 (Use the ADR letter as a cover sheet).
Providers should ensure the accuracy of their billing and send the following documentation when responding to the ADRs:
- Hospital history and physical
- Physician's orders for the admission and all services billed
- Plan of care
- Diagnostic test results/reports, including imaging reports
- Itemized list of all charges
- Clinical/therapy notes
- Hospital admission assessment
- Consultation reports
- Physician progress notes
- Hospital discharge summary
- Please submit all documentation to support the medical necessity of services billed and the DRG code billed
- If you question the legibility of your signature, you may submit a signature log or an attestation statement in your ADR response. Medicare requires that medical record entries for services provided/ordered be authenticated by the author. The method used shall be a handwritten or an electronic signature. Stamp signatures are not acceptable. Patient identification, date of service and provider of the service should be clearly identified on the submitted documentation.
Completed review results will be posted at www.cgsmedicare.com/parta. Individual providers with significant denials will be contacted for one-on-one education.
Questions regarding this review may be directed to the Medical Review department at (803) 763-4999.
