Wiki Changing Reason Code to match Remark Codes

[megasor1013]

I am fairly new to the audit world and I could use some guidance regarding a training topic that came up recently.

When posting remits, is it okay to change the reason code listed on the remittance to a higher specificity to match the remark code? For example, we receive a processing with a reason code of CO16 (very generic) but on the EDI report/remittance/phone call it is stating the issue is due to an incorrect place of service so we update the reason code to CO5.

Changing to the higher reason code allows for better trend tracking when pulling reports. From an audit standpoint could this scenario get messy. Any guidance would be appreciated.

 

[thomas7331]

Who is changing the codes and how are they doing this? Coders do not assign or change remark codes or denial reason codes as part of their usual coding duties - that is a payer function. I have never heard of auditing remittance advices for this type of information, but if you are doing so, you would need to be using some type of payer policy or HIPAA code set as your audit tool. This is really outside the scope of regular coding training. This sounds like a company-specific process so I think you’d need to get guidance from your employer about this.

 

[amyjph]

Agree, this really isn't a coding function.

This definitely sounds like some type of internal process with cash application and payment/ERA posting.