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Coding & Documentation Audits

Coding & Documentation Audits

The Funds processes and pays Medicare claims as a Health Care Prepayment Plan (HCPP) contracted through the Centers for Medicare and Medicaid Services (CMS). The purpose of the following summaries is to provide education about Medicare documentation guidelines to improve the quality of records needed to support the payment of Medicare claims paid by the Funds on behalf of CMS.

Medicare requires documentation which is legible, complete, appropriately authenticated and supports medical necessity for services reported on the insurance claim form. You may be audited retrospectively by the Funds or CMS to ensure that you have complied with all Medicare payment policies.

Disclaimer: This information is provided by the Funds as an educational summary and may not include all requirements for Medicare coverage and payment. This summary does not supersede the official policies of the Centers for Medicare & Medicaid Services, and compliance with the guidance in this summary will not necessarily ensure payment. It is each health care provider’s responsibility to understand and to stay current with all coding & billing guidelines, Local and National Coverage Determinations, and any other legal requirements of the Medicare program.


Ambulance Emergency Response Criteria

Ambulance Transport Services

Ambulance Signature Log

Chemotherapy & Non-chemo Injections/Infusions

Chiropractic Claims

Evaluation & Management (E & M) Services

Outpatient Therapy & Rehabilitation