Changing POS on claim to match CPT for billing

Birdie625

Networker
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49
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Holyoke
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I work for a Hospital and assist with the hospitalist's charges. I have a very small role in this. I have and do see often whereby the Hospitalist will charge an incorrect CPT for patient's location (I am not sure why they do that, as I don't know what they see in EMR/EHR) . The billing department then changes the POS to match the CPT to get the claim out (all insurances). To me, that is incorrect, but I have been told 'dont worry, not your department'. Example patient in OBS status...for some reason the Hospitalist will start entering IP codes (there is no IP order). I don't know enough about this nor know where to look (did search online, but issue was more of changing POS example IP/OBS to Office).

To me it just seems wrong, but I don't know enough to really drive it home. Any advice?? Thanks in advance. Birdie
 

thomas7331

True Blue
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It sounds like an inefficient and poor quality practice to me, and quite frankly a stupid one too, but I'm not sure I'd go so far as to say it's necessarily 'wrong'. In my experience most payers that receive a claim where the POS does not match the CPT will just deny the claim, so it's likely that these will just come back and have to be fixed on the back end. On the chance they are paying these, it's likely not going to make a big financial difference because the fee schedules for the codes sets are approximately the same across the different facility places of service, so billing with the incorrect code in this case, although incorrect coding, is unlikely to be considered a fraudulent activity because there's likely little to no financial gain involved.

The better way to do this though, and the better business practice, would be to have the documentation reviewed and the entire claim fixed to go out correctly the first time. There's a saying in healthcare that if you don't have time to do it right, how will you find time to do it over again? Doing it incorrectly leaves a practice open to audit findings, invites payer scrutiny, and makes the organization vulnerable to having to refund payments, submit records to payers for review, and re-work old claims down the road, which can end up costing everyone a lot more in the long run.
 

Birdie625

Networker
Messages
49
Location
Holyoke
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2
THANK YOU :) very much! I appreciate the feedback and agree w/your comment 100%. It is stupid and they (mgmt) don't get the concept of "do it right the 1st time". I can sleep better now with your feedback and so much appreciate it. I have mentioned this several times and feel I have no further obligation to the matter. I just wanted to ease my own inexperienced wondering of the issue. Thank you again, much!
 
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