Wiki Location different on note vs. location billed to insurance

[dpazzi61]

My physician sometimes does not use the same location on their documentation in the patient's chart as the location that was billed on the claim? They do not want to redo the documentation and believe it does not matter. Both locations used are our locations but they just don't match on note vs. charge. If a audit was done and the documentation location does not match the location billed will they recoup our money?

 

[thomas7331]

This could be a potential problem and it should be corrected. Which piece of information is incorrect - the documentation or the bill?

Medicare, and some other payers, require that every location be credentialed/enrolled in order to bill for services at that location. In addition, different locations could be paid at different rates if they are far enough to fall into a different region that has different reimbursements. If you are billing for services rendered at a location that isn't enrolled or would otherwise have been paid differently, but using a different location on the claim, that could in fact be considered fraud and result in a recovery of payments. If, however, both of the locations are valid and fall under the same rates and regulations, it is not likely to cause a payment error. But you still should not be reporting incorrect information to your payers, even if it is not creating payment errors.

On the other hand, if you claims have correct locations according to where your patients were actually seen but your provider is simply documenting the location incorrectly, if you were audited and the payer questioned this, you could potentially explain this to a payer by showing in your appointment records that the patient was actually seen at the location where you billed and that the claim is correct. But why put the practice in this position? Your providers should just document correctly the first time so that there is no confusion or question in the event that the records are ever reviewed.

 

[dpazzi61]

Can you tell me where I can get this information in writing so I can use this as a teaching moment?

 

[thomas7331]

If you go to your local Medicare carriers web site and look under their section for provider enrollment and claim submission information, you should be able to find the instructions for enrolling a new office location for your practice, as well as instructions for completion of the claim forms which will indicate that the location where services are rendered needs to be populated in box 32 of the professional claim form.