Wiki Is this illegal ? Beefing up E/M levels for RVU's??

Create Wiki
L

Linda77

Guest
Messages
63
Location
Del Rio, TX
Best answers
0
As part of the new process at our facility we are required to tell the provider that the level they have selected will be down or up coded to match the documentation.
Now what is happening is the doctor(s) are coming back and saying they will add more documentation after the fact so they can receive a higher level or the one
the originally selected. This feels wrong since the motivation is ($$$) RVU's. Upper management doesn't think anything is wrong with this. Am I over reacting here or does
anyone else see a problem with this?? If you agree with me please if you have anything that I can show as proof I would greatly appreciate it!
 
Linda77 said:
As part of the new process at our facility we are required to tell the provider that the level they have selected will be down or up coded to match the documentation.
Now what is happening is the doctor(s) are coming back and saying they will add more documentation after the fact so they can receive a higher level or the one
the originally selected. This feels wrong since the motivation is ($$$) RVU's. Upper management doesn't think anything is wrong with this. Am I over reacting here or does
anyone else see a problem with this?? If you agree with me please if you have anything that I can show as proof I would greatly appreciate it!
Click to expand...

Hello,

I agree with you! A provider should not go back and amend e/m documentation once they are notified it does not support the level of service. Unfortunately, if your management doesn't have a problem with it you have to follow their directives.
 
I agree this is not right and probably not a compliant practice, and if such a pattern was identified in an audit, a payer could in fact take the position that those additions to documentation are inadmissible. Returning documentation to providers for amendments or corrections should be limited to situations where documentation in unclear or incomplete or contains errors, and not for purposes of increasing revenue. There have been a lot of articles written about compliant queries. As a start, I'd recommend searching for some articles about compliant queries - here are a couple to get you started, both of which discuss the fact that queries should not be design to lead providers. If I were in your place, I would report this process to my organization's compliance officer for review.

https://www.aapc.com/blog/27616-use-queries-to-prompt-complete-documentation/

https://www.icd10monitor.com/cdi-queries-why-must-they-be-compliant
 
There is a distinction to be made between educating providers about the requirements for each level of E/M service in general, and specifically prompting providers to document more than required by medical necessity to increase the bottom line.

This case you're describing sounds decidedly like the latter. All of those "redocumented" encounters are probably upcoded and fraudulent. Definitely a good time to talk to your compliance officer. Not trying to be flip, that is a genuine suggestion.
 
Linda77 said:
As part of the new process at our facility we are required to tell the provider that the level they have selected will be down or up coded to match the documentation.
Now what is happening is the doctor(s) are coming back and saying they will add more documentation after the fact so they can receive a higher level or the one
the originally selected. This feels wrong since the motivation is ($$$) RVU's. Upper management doesn't think anything is wrong with this. Am I over reacting here or does
anyone else see a problem with this?? If you agree with me please if you have anything that I can show as proof I would greatly appreciate it!
Click to expand...


Hello

The doctors CANNOT go after the fact once patient gone and notes done to try to boost the notations. What ???!??!?! The need to do this with patients from now on.
Lady T
 
You must log in or register to reply here.
Top