Palmetto Denials • Filling Out Forms for Patients • Enrolling in Medicare

QUESTION: I have sent three appeals to Palmetto that have been denied. I also sent operative reports along with the appeals. The explanation of their decision states that there are “acceptable methods of signing records/test orders and findings.” What does this mean?

ANSWER: Claims processed by Palmetto GBA on or after April 28, 2008 (for dates of service beginning with September 3, 2007), have new signature requirements. Medicare requires the individual who ordered/provided services to be clearly identified in the medical records. The signature for each entry must be legible and should include the first and last name of the practitioner. For clarification purposes, Palmetto recommends you include your applicable credentials, e.g., PA, DO, or MD. The purpose of a rendering/treating/ordering practitioner’s signature in patients’ medical records, operative reports, orders, test findings, etc., is to demonstrate the Part B services have been accurately and fully documented, reviewed, and authenticated. Furthermore, it confirms the physician has certified the medical necessity and reasonableness for the service(s) submitted to the Medicare program for payment consideration. For more information on this topic, please go to Palmetto’s website www.palmettogba.com/J1B and search for the article entitled, “Medicare Part B Medical Records: Signature Requirements, Acceptable and Unacceptable Practices.”

QUESTION: Sometimes my office staff fills out forms on our patients’ behalf. Are there any steps I should take before I start charging my patients for the completion of forms?

ANSWER: Yes. You may wish to consider reviewing all managed care contracts to see whether there are any restrictions. Some contracts may only allow you to bill patients for co-pays and deductibles. This may be interpreted as a prohibition against charging for forms. Contact your payers. You may want to let them know you plan to institute a charge for form completion and avoid problems down the road. Also, notify your patients ahead of time. This will avoid surprise and hard feelings. Office staff should be briefed on exactly how to respond when patients question the need for the fees or ask whether the fee can be waived.

QUESTION: I am a brand new physician to Medicare. How do I enroll?

ANSWER: If you are brand new to Medicare and you are going to fill out an 855I or 855R application, you can now do this online at www.cms.hhs.gov/medicareprovidersupenroll. However, if you need to change from a solo proprietor to a solo incorporated physician, you must still do this via paper. The link above can currently only be used for new providers and reporting other practice changes.