Question Coding Changes made by AR Staff

mdm58

Networker
Messages
72
Best answers
0
We have three AR people in my office that often will change my coding. If the claim denies for any reason (ie: request for med records) if the claim has modifiers listed for pacemakers or defibrillators or TAVRS the AR people first just remove the modifiers and rebill the claim instead of sending the records are calling insurance company to get reason for denial if its not for med records and then when claim denies again I receive it back with a note from them that I billed the claim incorrectly. Does anyone else have this problem and if so how to I handle this situation?
o_O
 

Jessim929

Guru
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104
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0
Do you print a report of charges when you code and post them? If not, you should. Print it and keep it in a file - or scanned with records. THEN, when this happens again, you have proof to escalate it to management that your work is being changed by someone other than you.
 

Henson65

Networker
Messages
46
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0
How do you submit the codes to the billing team? Is it through some sort of electronic system? If so, there can be an audit run to see who changed the coding and when it was changed.
 

Pathos

True Blue
Messages
614
Location
Beaverton OR
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1
I would start by talking to your supervisor/manager, and then perhaps your Compliance Officer. I think communication is key here.
 

mdm58

Networker
Messages
72
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0
I submit the codes electronically and am able to view who changes the codes or removes modifiers from the claim. And our supervisor who is the practice manger is aware of the problem. Would I still be liable for any fraudulent claims they file. Also they will leave my name as the owner of the claim as if I made the changes to the claim!
 
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