This module outlines everything you need to know to understand about Medicare Advantage Plans and how they may impact your policies and procedures with regard to Medicare billing practices.

This module provides the background for how to manage each of the different scenarios team members might encounter including the importance of identifying Qualified Medicare Beneficiaries (QMBs).

Medical records chronicle the details and happenings of a Medicare patient’s visits to the office. For services to be eligible for payment, patient records must be properly authenticated and signed according to Medicare’s signature guidelines. Likewise, all third-party payers, not just Medicare, have a signature standard

There is a common misconception in the profession that once doctors demonstrate PART in their documentation they have proven medical necessity. Sadly, Medicare and its designated auditors do not ascribe to this ideology. Even though PART is a crucial element in the documentation for Medicare, it is not the only requirement.

Medicare coverage guidelines dictate that services meet their definition of Medical Necessity to be considered for reimbursement. Providers must understand this definition in order to properly document and manage the patient’s active treatment case. Although patients may have pain, without functional loss, medical necessity is difficult to prove.

This Module will provide an overview of P.A.R.T. and explain how to properly document it in the patient’s chart.