1. Medicare Coverage Issues OSMO April 11, 2015

2. Medicare Services Services Must be Medically Necessary - Provider Attestation on Claim - Supportive Documentation in Patient Chart

3. Infusion Services Infusion Services Only -Provider Attestation to Medically Necessary -Supportive Documentation in Patient Chart What is the nature of the documentation?

4. Infusion Services (2) E & M plus Infusion Services

5. Modifier 25 E & M service beyond other service provided beyond preoperative or post operative care associated with procedure E & M may be prompted by the symptom OR condition for which the procedure service was provided. Separate Dx NOT required The circumstance may be reported by adding Modifier 25 to the appropriate Level of E&M

6. Physician Work Infusion Services- Supervisory in Nature – No Face to Face time with patient and consists of -Provision of an Order -‘Incident to’ requirement: to be immediately available in suite for nursing questions or problems

7. Physician Work E & M Visit – PreService-Reviewing medical history and other information – Intra-Service- Direct Face to Face for detailed history including response to treatment at last visit. Physical Exam. Consider relevant data, formulate diagnosis and update and manage treatment plan and discuss with patient. – Post service- Documentation and correspondence, care coordination

8. Documentation Issues Infusion Services documentation by OCN E & M documentation by Qualified Provider – Attention to Medically Necessary provisions – Diagnosis need not be different but reason prompting the E&M service must be separately identified