jarmstrong20
New
Hello, all! I am a coder, and my wife is a PCP. We work for different health systems in our area. Recently she started to receive what can be compared to a CDI clarification for patients who are scheduled for an outpatient visit (they have not yet been seen). These are coming from people with CPC credentials, and not RNs. Also, these are clearly stated that they will not be part of the medical record. For example, one of them stated that the patient had been diagnosed with diabetes 3 years prior by one of her colleagues, and what does she think about that. Another quoted a CT scan from a year ago that showed calcification and that she should diagnose them with PVD.
I am not an expert on clarifications or queries, but I smell fraud here. I need help to better understand what is happening. I code for a hospital, so my outpatient experience is limited. I am not aware of the process for a coder to scour a patient's chart prior to a visit and then requesting/directing the physician to "pay attention to this problem." Is this practice commonplace? If so, does it have a different name other than a query or clarification?
To me, this is a blatantly fraudulent activity that is intended to direct the physician to boost the severity of the patient's condition. Although I support capturing the patient's complete health picture, if it is not clinically relevant and validated for the current encounter than it is not applicable. The appearance is that they are trying to introduce diagnoses without evidence, and want to hide that process.
I would appreciate any assistance in trying to better understand what is happening. Is this practice normal and compliant? I suspect the answer is a resounding "No!" Are there other resources that you can point me to in order to investigate further?
Thank you all for your help!
I am not an expert on clarifications or queries, but I smell fraud here. I need help to better understand what is happening. I code for a hospital, so my outpatient experience is limited. I am not aware of the process for a coder to scour a patient's chart prior to a visit and then requesting/directing the physician to "pay attention to this problem." Is this practice commonplace? If so, does it have a different name other than a query or clarification?
To me, this is a blatantly fraudulent activity that is intended to direct the physician to boost the severity of the patient's condition. Although I support capturing the patient's complete health picture, if it is not clinically relevant and validated for the current encounter than it is not applicable. The appearance is that they are trying to introduce diagnoses without evidence, and want to hide that process.
I would appreciate any assistance in trying to better understand what is happening. Is this practice normal and compliant? I suspect the answer is a resounding "No!" Are there other resources that you can point me to in order to investigate further?
Thank you all for your help!