rdarla
Guest
I work for a payer and do Post Payment Review on inpatient medical records. A frequent case scenerio envolves coding review finds the facilities coding substantiated per the documentation in the chart notes and according to ICD-9-CM guidelines. Review by Medical Management finds that clinical criteria supporting a diagnosis (usually the principal diagnosis) has not been met. Coding feels pressured to change their review to reflect Medical Managements determination. I would be interested to know if others who work for payers experience this problem and if you have a solution for resolution.