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MLN Products

MLN Provider Compliance

The Medicare Learning Network

FAST FACT

Issue: Medicare is denying an increasing number of claims because documentation submitted for diagnostic tests does not include signed test orders or evidence of intent (MD progress notes listing tests needed) and evidence of medical necessity (description of clinical conditions and treatment showing the need for the testing).

Guidance: While the physician’s signature is not required when initially ordered for clinical diagnostic tests, upon review by Medicare contractors, there must be evidence to support the physician’s intent to order the tests performed and documentation of medical necessity is required. Claims may be denied if signatures, evidence of intent, and medical necessity are missing. If the physician signature is not legible on an order or progress note, providers may submit a signature log or attestation statement to support the identity of the illegible signature.

For more information, please refer to the Medicare Learning Network® publication titled “Complying with Medicare Signature Requirements”.

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The Medicare Learning Network® (MLN) Products Provider Compliance page contains educational products that inform health care professionals on how to avoid common billing errors and other improper activities when dealing with various CMS Programs. CMS’ claim review program’s overall goal is to reduce improper payment error by identifying and addressing coverage and coding billing errors. Since 1996, CMS has implemented several initiatives: to prevent improper payments before a claim is processed; and to identify, and recoup improper payments after the claim is processed.

The Downloads section contains MLN products, MLN Matters® Articles, and the “Medicare Quarterly Provider Compliance Newsletter” which have been designed to provide education on common billing errors and other improper activities. These lists, as well as other information in the Downloads and Related Links section, are updated as new products and articles are developed and existing products and articles are revised.

If you would like to contact the MLN, please e-mail us at MLN@cms.hhs.gov.

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