Medical Billing Guidelines Made Clear

The Centers for Medicare & Medicaid Services can sometime seem a little vague in their guidelines. It is common knowledge in the medical billing world that a physician or non-physician practitioner must perform the history of present illness portion of an evaluation and management exam. However, this medical billing rule is nowhere to be found in the CMS guidelines.

After examining the Center for Medicare & Medicaid’s guidelines, many people wonder if an ancillary staff member instead of a physician can take the history of present illness. Nowhere in the documentation does it prohibit this to be done. Most medical billing policies are spelled out exactly how they should be accomplished. This isn’t always the case with Medicare and Medicaid guidelines.

The Centers for Medicare & Medicaid Services state in the medical billing guidelines that the family and social history (PFSH) and the review of systems (ROS) can be completed by an ancillary staff member. There is absolutely no mention of these ancillary staff members being allowed to take the history of present illness portion. This omission in the medical billing guidelines has led to the restriction. The only way the ancillary staff member can take any information during the evaluation and management is if the guidelines specifically state so.

If you’re tired of trying to disseminate the sometimes vague information given to your staff in order to get your medical billing claims reimbursed, it might be time to consider outsourcing your medical billing claims to a third party partner who can keep up with the changes and know how to get your practice the maximum revenue returns on your services rendered to your patients.

View all Articles by: Melissa Clark, CCS-P