March 5, 2001

Medi-932-01

TO: ALL MEDICARE PROVIDERS

SUBJECT: PROGRESSIVE CORRECTIVE ACTION- UPDATE

PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS

EFFECTIVE DATE: APRIL 1, 2001

Medi 837-00 (9/25/00) contained a copy of HCFA Program Memorandum AB-00-72 dealing with Progressive Corrective Action. The following is an update to that information.

When Medical Records are not returned timely our current practice is to Return to Provider (RTP) the claims. Program Memorandum AB-00-72 originally indicated effective October 1, 2000, we would deny claims rather than RTP when requested Medical Records were not returned timely. HCFA delayed the effective date of this change until April 1, 2001.

Effective April 1, 2001 if the requested documentation necessary to review the claim is not received timely, the claim will be denied rather than RTP’d. . The Appeal process will be the only avenue for payment consideration for claims denied for lack of submission of Medical Records. We encourage our providers to submit the requested medical records within the time frames specified. This will expedite the processing of your claims, prevent unnecessary denials, and prevent the added time and expense of initiating an Appeal.

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com

Please refer any questions to our office at (423) 755-5950.