Blepharoplasty / Visual Fields Documentation Requirements - JF Part B
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Blepharoplasty / Visual Fields Documentation Requirements
It is expected that patient's medical records reflect the need for care/services provided. The listing of records is not all inclusive. Providers must ensure all necessary records are submitted to support services rendered. They may include:
| Check box if submitted | Brief Description |
|---|---|
| Beneficiary name and date of service on all documentation | |
| Practitioner, nurse, and ancillary progress notes | |
| Diagnostic Studies, including visual acuity and glare tests | |
| Operative / procedure report | |
| Visual field measurement / documentation | |
| Photographs showing visual impairment | |
| Documentation to support that the service provided was medically necessary and not cosmetic | |
| Copy of Prior Authorization decision letter which includes assigned UTN | |
| The topical corticosteroid(s) given previously to beneficiary for ocular inflammatory condition prior to current treatment | |
| The diagnosis of neovascular (wet) macular degeneration has been firmly established (fluorescein angiogram) | |
| Ocular Photodynamic Therapy (OPT) treatment notes, including initial and subsequent treatments | |
| Documentation supporting the diagnosis code(s) required for the item(s) billed | |
| Documentation to support the code(s) and modifier(s) billed | |
| List of all non-standard abbreviations or acronyms used, including definitions | |
| Documentation to support National Coverage Determination (NCD), Local Coverage Determination (LCD) and/or Policy Article | |
| Signature log or signature attestation for any missing or illegible signatures within the medical record (all personnel providing services) | |
| If an electronic health record is utilized, include your facility's process of how the electronic signature is created. Include an example of how the electronic signature displays once signed by the physician | |
| Advance Beneficiary Notice of Non-Coverage (ABN)/Notice of Medicare Non-Coverage (NOMNC) |
Multiple CMS contractors are charged with completing reviews of medical records. See Identifying Which Entity Completed a Part B Claim Review for detailed information about each of these contractors.
Documentation Submission
Once a provider/supplier compiles all the necessary documentation, it is important to submit them to the appropriate contractor according to the request received. Select the request below to view the appropriate submission instructions.
- Noridian Medical Review - Automated Development System (ADS) Letter
- Comprehensive Error Rate Testing (CERT) - CID Request
- Level One Appeal - Redetermination Request
Last Updated Wed, 27 Oct 2021 12:26:38 +0000