Internal Medicine Subsequent Hospital Care
Internal Medicine Subsequent Hospital Care, 99233 - Northern CA, Southern CA, and NV Widespread Service Specific Targeted Review Notification
CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. To meet this requirement, Noridian Part B Medical Review (MR) analyzes national and local data in conjunction with the findings from the Office of Inspector General (OIG) and other CMS contractors such as Comprehensive Error Rate Testing (CERT) and Recovery Auditor (RA) to identify atypical billing. After data analysis, MR must verify if billing problems exist through claim reviews to validate provider compliance with Medicare coverage as well as coding and billing guidelines. If issues are identified, MR then determines the severity of problems and develops interventions to correct the problem.
Effective July 6, 2015, Noridian will initiate claim sampling from providers and suppliers located in Northern California, Southern California, and Nevada who bill for the following services:
• CPT ® 99233: Subsequent Hospital Care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed examination; medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.
Your facility will be notified of the selected claims per the normal Automated Development System (ADS) process. The provider agreement to participate in the Medicare program requires the submission of all documentation necessary to support the services billed on the claim. Please review all of this information carefully and in its entirety.
View the appropriate widespread service specific targeted review notifications at:
· Nevada
It is imperative that all providers check and review the website on a regular basis for further updates and notification of the implementation of further Widespread Service Specific Targeted Reviews.
Last Updated Jun 22, 2015