What happens to services not clearly documented according to Medicare guidelines in claims?

When services are not clearly documented in accordance with Medicare guidelines, they are typically returned for further documentation. This process is in place to ensure that all services billed are adequately supported by the necessary paperwork, catering to the requirements for appropriate billing and compliance. The purpose of this protocol is to protect both the provider and the Medicare system from fraudulent claims and to ensure that beneficiaries receive the services they are entitled to based on accurate and complete records. Proper documentation is essential for validating the medical necessity and appropriateness of the services provided. If the documentation falls short, it reflects on the clarity and comprehensiveness of the records, prompting a request for additional information before any decisions regarding payment or denial are made.