Difference of opinion between Coder and Provider


Parma, OH
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I am looking for some feedback how other places handle if there is a difference of opinion when it comes to documentation between the coder and provider.

Thank you


True Blue
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There are two suggestions that I've received from experienced auditors that come to mind which I think are very helpful in avoiding conflict and in resolving differences in opinions on coding issues with providers.

One audit company we worked with used the term 'variance' rather than 'error' when a coder came up with a different code from the provider. A coding 'error' suggests that the provider is wrong and that's not a good footing to start a discussion about a coding difference. If you identify it as a 'variance' and then lay out the reasoning that the coder arrived at a different code, that provides a better opening for discussion of the coding guidelines and opportunity for education.

The second idea - a similar strategy actually - is to always present audit findings in draft form and allow a discussion or rebuttal to take place with the provider before giving them a final decision. This also leaves the door open to discuss and education for both coder and provider, and gives the provider opportunity to explain their choice. Providers can often be very persuasive in explaining their coding and if the coder can learn and incorporate that reasoning into their work, it can make them a better coder too and will better equip them to defend their own coding choices or write appeals if needed.

Hope that helps some.