What happens if the medical records in support of a particular claim are deemed by Medicare to be incomplete or insufficient?Incomplete records can result in denial of payment for services billed to Medicare. In order for a claim submitted to Medicare to be valid, there must be sufficient documentation in the provider's or hospital's records to verify the services performed were 'reasonable and necessary' and required the level of care billed.If there is no documentation or insufficient documentation, then there is no justification for the services or level of care billed. Additionally, if there is insufficient documentation on the claims that have already been paid by Medicare, reimbursement may be considered an overpayment and the funds can be partially or fully recovered. | |
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