Medicare Compliance & Reimbursement

Hint: Put your query in writing to avoid confusion.

Subpar documentation ranks among the top reasons for Medicare claims denials. Sometimes reports contain conflicting statements, or the notes are missing information that is critical to selecting an appropriate code. And more often than not, it is simply the case of illegible handwriting that leads the coders and billers to input the incorrect code.

These are all cases that might warrant a "query" to the physician, so that you can update the medical record to accurately reflect the situation. Read on for some tips to improve your query process.

What it is: "A query is a routine communication and education tool used to advocate complete and compliant documentation," according to the American Health Information Management Association (AHIMA). "The desired outcome is an update of the health record to better reflect the provider's intent and clinical thought process," AHIMA adds.

Make a Query Form

Written queries are best, but they can be verbal if you document the exchange. You can use email for a query if your system is secure and HIPAA-compliant, according to Leonta Williams, RHIT, CPCO, CPC, CEMC, CHONC, CCS, CCDS, director of medical coding at Georgia Cancer Specialists in a presentation at American Academy of Professional Coders Regional Conference in Salt Lake City.

Ideally, you will have a query form that you fill out to ensure consistent procedures for gathering and documenting information. The following guidelines will help you make good use of this tool

Your query forms should:

• List the patient's name, date of service, medical record number, provider's name, name and contactof the individual sending the query, date ofquery.
• Present the facts of the scenario.
• Using a question, identify where clarification is needed.

Query forms should not:

• Be designed so that the only thing needed is a physician's signature.
• Indicate any financial impact.

Remember: Strong clarification questions are key to queries, and there's an art to writing good ones. It's wise to steer clear of "leading" questions that box a clinician into one response. Query writers should also avoid statements that put providers on the defensive. The end result of queries should always be to resolve issues - not create more problems.