Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management

Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for home PT/INR monitoring for anticoagulation management:  

• Missing medical documentation to support medical necessity 

• Missing documentation to support the beneficiary has completed an educational program on anticoagulation management and the use of the device prior to its use

• Missing electronic signature or legible signature of the referring provider

Related Content

• Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 190.11 (Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management)

• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Sections 60 and 60.1 (Coverage and Billing Requirements)

• CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4 (Signature Requirements)

Reviewed 11/14/2024