Thursday, October 20, 2011

ESRD claim documents for process

File End Stage Renal Disease (ESRD) Clinic Claim along with Document

•    Please be sure documentation submitted is legible.
•    Please submit records for all dates of service on the claim.
•    Please ensure the medical records submitted provide proof the service(s) was ordered and rendered. Also, ensure the medical records provide justification supporting medical necessity for the service by submission of the following documentation:
o    Physician’s orders for all services rendered (i.e., standing orders, annual renewal orders and specific orders for all services billed during the dates of service).
o    Written long-term program (revised annually), written patient care plan.
o    Short-Term Care Plan (STCP).
o    Diagnosis.
o    Dialysis start date.
o    Daily dialysis flow sheets.
o    Dietitian’s notes.
o    History and physical.
o    Social worker’s notes.
o    Nurse’s notes.
o    Physician’s progress notes.
o    Medication administration records, indicating amount given, wastage, route of administration, dates and time given.
o    Copies of provider’s protocols utilized to tailor a patient’s therapy, with reports of diagnostic tests, treatments and clinical findings.
o    Signatures/credentials of professionals providing services.
Plus any documentation a provider deems necessary to support medical necessity of services billed, as well as documentation specifically requested in the Additional Documentation Request (ADR) letter.

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