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Wiki Internal Audit

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maine4me

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If I audit a charge for a preventive visit and the doctor does not have a comprehensive history (ROS and PFSH) or a comprehensive exam, my understanding is the visit would not qualify as preventive. Now in a post pay audit, then charge would need to be refunded, however is it appropriate to recode as an E/M based on what documentation is available?

Also, if a charge has been overcoded and the insurance applied it to the deductible what is the appropriate way to notify the insurance.? It seems unfair that this would affect the patient's deductible.
 
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