Fillable Checklist: Responding to requests for medical documentation (Medicare & Medicaid)

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Checklist: Responding to requests for medical documentation (Medicare & Medicaid)

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04/08/2020
First Coast Service Options Inc. (First Coast)
Comprehensive Error Rate Testing (CERT)
Recovery Auditor (RA, formerly RAC)
2. Identify timeframe to submit documentation:
3. Identify acceptable submission method:
Checklist: Responding to requests for medical documentation
This checklist is an aid to assist providers with responding to medical record documentation requests. The provider of services
must ensure correct submission of documentation to the appropriate Medicare contractor within the specified calendar days
outlined in the request and in accordance with the contractor's acceptable submission method. Please work directly with the
requesting contractor to resolve any questions regarding your compliance with the request..
The following principles should be followed when submitting medical documentation.
1. Identify the requesting contractor:
First Coast -- 45 calendar days
CERT -- 75 calendar days
RA -- 45 calendar days
First Coast -- CD/DVD, fax, hardcopy, or esMD
CERT -- Fax, CD, or esMD
RA -- CD, electronic, or hardcopy
4. The documentation should include but is not limited to:
Specific documentation requested in the ADR letter
Name of beneficiary and date of service on all documentation
Signed and dated physician's orders, test results, and progress notes, if applicable
Complete and legible medical records for all dates of service on the claim under review
For evaluation and management (E/M) documentation requirements, please refer to the E/M Checklist
12/18/2018
To avoid providing insufficient documentation:
Disclaimer: This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation
requirements published in national or local coverage determinations, or the Centers for Medicare & Medicaid Services' documentation
guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of
documentation.
Procure any necessary documentation from third-party providers, if applicable
Provide legible identifiers for all who contributed to the services and medical record
Include all required signatures following Medicare's signature guidelines
Include all documentation that may support medical necessity of services billed
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Checklist: Responding to requests for medical documentation (Medicare & Medicaid)

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Completed 10 January 2021

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