Wiki Documenting HPI

[TheStephCode]

We shall beat this dead horse once again.

Does anyone have a source from any commercial payer(s) that specifically states a provider must document the HPI, or that the commercial payer follows Medicare guidelines? Our MAC is very clear on the matter but our providers want to see it "in writing" from other payers. Any help much appreciated as I've been googling to no avail. Thanks!

BTW, as a heads up, they also challenge that a guideline is a guideline and not a hard fast rule. Good times!

 

[jsalzer50]

Commercial HPI responses

Here is a link I found about Commercial Insurance Companies replies to HPI documentation:

https://www.google.com/?gws_rd=ssl#q=commercial+payer+requiring+history+of+present+illness

Then click on the second option "Commercial Payer Responses - wmgma" PDF file (specifically page 2 of that PDF)

That has the responses of some commercial payers re: HPI. Hope this helps!

Sincerely, Jacob

 

[Cheezum51]

If you read articles by some of the better known ophthalmology billing and coding writers, some of whom also do record audits, they emphasize that the provider is supposed to record the HPI and the record should reflect that they've done it personally.

They apply this requirement to both Medicare and other commercial carriers and say that they would fail an provider on this part of the record if they don't note that they've done this.