Medicare documentation

[Guest guest]

Here's another question.

Regarding a Medicare patient. We file electronically.

First Question:

If the claim isn't denied and Medicare pays, how would Medicare know if you

had a signed P.O.C. or not?

Second question:

Had an initial claim that some body put the KX modifier on the claim the

first visit and this remained for the next 4-5 visits. Medicare denied this

claim stating the documentation didn't substantiate this level of care bla,

bla, bla. This is a total joint patient w/ OA, and IDDM, so I'd think she

would qualify for skilled PT. Did having the KX modifier on the claim cause

the denial? If so, then if we re-submit without the KX do you think this

will be enough or do I need to go through the whole appeal letter scenario?

Jeff LePage, PT

Wasilla, Alaska