January 12, 2016
Progressive Corrective Action (PCA) Review: Home Visits
The J15 Part B Medical Review department performed Progressive Corrective Action (PCA) reviews on home visits throughout the year. The findings from PCA reviews occurring over 2015 are as follows:
- Failure to support the medical need for a home visit in lieu of an office visit
- Failure to meet the key component levels required for the code billed,
- Medical necessity was not supported,
For more information on Medicare guidelines, including documentation required to process a claim, please refer to:
- CMS 1995/1997 Documentation Guidelines for E/M Codes
- Entries in Medical Records: Amendments, Corrections and Addenda
- Signatures and Compliance: Practitioner Offices and Billing Services
CMS Internet Only Manual
- CMS Pub 100-4 Claims Processing Manual, Chapter 12, Sections 20.1, 20.3, 30.1, 40.1, 30.6.1 B and C
- CMS Pub 100-4 Claims Processing Manual, Chapter 12, Sections 30.6.14 and 30.6.14.1
- CMS Pub 100-8 Medicare Program integrity Manual, Chapter 3, Section 3.3.2.4
Social Security Act