Consultation

Introduction for Consultation

Effective January 17, 2006, the Centers for Medicare and Medicare Services ("CMS") requires new documentation for consultations. According to Medicare Transmittal 788 (http://www.cms.hhs.gov/transmittals/downloads/R788CP.pdf), the reason and the outcome for the patient consultation must be documented in the medical records of both the ordering physician and the consulting specialist.

These new requirements represent a very significant change in documentation. CMS issued these new requirements based on an audit conducted by the Office of Inspector General of the Department of Health and Human Services. The OIG audit determined in 2001 Medicare paid approximately $1.1 billion more than it should have for consultations and that 75% of services billed as consultations did not meet requirements. In addition, the OIG found that 95% of consultation claims billed at the highest level were miscoded.

In response to these new requirements, the Office of Compliance has developed a new policy regarding consultations.

Consultation Policy & Quiz

Consultation Policy
Consultation Request Form
Document Decision Tree for a Consultation v. Transfer of Care
OPTIONAL Consultation Quiz on WebCT

Consultation Policy and Document Decision Tree combined (.doc file)