Make it a screening?

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282
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Pensacola, Florida
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I need opinions on your process. What does your office do when, after a patient is quoted an estimated out of pocket cost for a diagnostic colon, the referring MD calls over to request a diagnostic colon be changed to a screening so the patient can access their 100% screening benefit? What if the colon had already been done, but not billed out yet? What if your Dr said "okay"? I understand the principles and don't want this to turn into a huge debate over what's right and wrong. I'm just wondering how other handle this delicate situation.
Thanks!
 

mitchellde

True Blue
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13,538
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Columbia, MO
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The claim must match the documentation. Delicate though it may be, you do not want this to come back and haunt. Why was the colonoscopy scheduled in the first place?
 

JDV7980

Networker
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This has happened recently to me. The patient was already here waiting in the prep room and had talked to the physician. My physician was actually the referring physican (from our clinic) and agreed to change the order so that pt. could utilize the scrn benefit. I talked to my physician and told her that we can not do that, that if the procedure was requested because of *insert signs/symptoms here* then that is the indications, not the screening. My physician didn't see the big deal, and went through with it. It caused me tons of heartache but at least I spoke with her and gave her the reasons why I felt it was ethically and legally wrong... my physician was sympathetic to what I was saying but more sympathetic to the patient and her finances, which I got to admit, so was I but at the end of the day this issue really is about whats right and whats wrong, ethically. Sorry. :) All I can do is give my physicians the knowledge and then hope and pray that they are receptive to it. Also, since it was heavy on my heart, I spoke with my administrator (who is very understanding) and she stated it is the physicians call. My advice, just educate your physician and then the rest is up to them. I know it's frustrating... but I really don't know if there is anything else we could do.
 
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282
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Pensacola, Florida
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The original indication was constipation. The report will be amended to say "screening", so the claim will match the documentation. I just wonder how other practices handle it when the paper trail on file started with a symptom, then at the request of the referring MD, the reason is changed so the patient can get it covered at 100%. Do other practices comply and change it so the patient can access their screening benefit?
 

mitchellde

True Blue
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13,538
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Columbia, MO
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I am sorry but this is wrong on so many levels, I totally disagree and having the report amended is also wrong, this is why EMR documentation should be locked so it cannot be "adjusted" in this way, however there will be the electronic footprint to show that the record was accessed a second time. If the patient presented with this symptom and that is why the physician ordered the study then it must remain this way. Your practice needs this statistic to show that this symptom requires this study to thoroughly investigate the issue. If you continually "play" with the reason for tests "just to get it paid" then there is nothing to base future arguments and decisions on. I would not do this, even if it meant being fired I would not do it.
 
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