What should the Chief Compliance Officer do first when faced with increased correspondence challenging medical necessity?

In a situation where there is increased correspondence challenging medical necessity, the Chief Compliance Officer should prioritize documenting the incident. This step is crucial because it creates an official record of the challenges and concerns raised regarding medical necessity. Documentation serves multiple purposes: it provides a clear account of the communications and issues raised, establishes a timeline of events, and helps to ensure that there is a formal basis for any subsequent actions or investigations.

Thorough documentation can also assist in analyzing patterns over time, better understanding the scope of the challenges, and formulating responses to the correspondence. By having a comprehensive and formal record, the Chief Compliance Officer can ensure that all relevant information is considered in any future evaluations or discussions.

Once this documentation is in place, it would be logical to proceed with reviewing the claims in question, compiling additional documentation, or engaging with billing staff to address the concerns effectively. However, without first documenting the incident properly, any subsequent actions may not be grounded in a clear understanding of what has transpired, potentially leading to missteps in compliance management.