How long to wait for corrected charting

lnld9

New
Local Chapter Officer
Messages
6
Location
Spokane, WA
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0
Hi Everyone,

I've been sending my provider 3 encounters, one for how many lesions she did cryo on (document states 5+, when I emailed to ask, she stated 4, asked her to add addendum to state that), and the other 2 were for trigger point injections (she stated 10 trigger point injections were done, but did not state how many muscles were involved). These have been outstanding since November and I send her an email at least once a week for her to fix it. My supervisor gave the other coder in my team these encounters to review and accept the charges... other coder accepted the charges as is and the provider never corrected her documentation... These were accepted 01/09/2019... these visits were for end of November/Middle of December... I've been coding for 5 years now, but I've never ran into an issue where the provider does not add what little documentation I request, or a practice that submits claims where the documentation doesn't match the codes. I was also not told that the other coder would be taking on these encounters... and when I went to follow up on them, I saw they were already accepted and on their way to the insurance.

Is this normal for other practices to just go with what the providers have entered although their codes chosen doesn't match the documentation requirements and definitions?

Thanks for the help,
L
 

Agilbert3

Networker
Local Chapter Officer
Messages
40
Location
SHREVEPORT/BOSSIER CITY
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0
Hopefully not.

With 5 years of experience, your instinct that this is not correct is probably right. I'm a new CPC-A myself, coding for a RHC, and this post really resonates with the obstacles I am facing. There's a solid go with the flow mentality. Our manager tends to go over me and expect me to just do whatever the revenue manager or records lady deems appropriate. In those cases, I research their decision and verifying it's okay before following through.

Also, I have a couple of providers that really don't care if anything above the baseline procedure is reimbursed. Sometimes they deem the work involved in proper documentation isn't worth the extra income. Which is absurd, but go figure.

But we're RHC and skills, supplies,staff, and time are stretched thin. I would say that's the only reason my situation is acceptable. A regular clinic/ facility should have it together.
 

kdlberg

Networker
Messages
42
Location
Orlando
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0
But we're RHC and skills, supplies,staff, and time are stretched thin. I would say that's the only reason my situation is acceptable. A regular clinic/ facility should have it together.
RHC & FQHC have different billing rules, so on the one hand, I get where your providers are coming from (that it won't change the reimbursement.) On the other hand, from a legal standpoint the record and the claim need to match. What if that patient sued, and the documentation conflicted?

Some of the EHRs I've used, they allow the queries to be saved as part of the patient record. I would do that, so there is proof that you, at least, did your due diligence.
 
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