Wiki OP reports, please help

[jdybus13]

In my office there is a difference of opinion on attaching OP reports when submitting our HCFA's . Can anyone offer some advise how they handle the original submission. Is it with or without the reports? Also our claims usually are over 50K. THANK YOU in advance

 

[karlene.dittrich]

Having many years of experience in billing and insurance reimbursement, my philosophy is "Never Hand Feed A Tiger." As a claims handling compliance and appeal specialist addressing payer denial tactics on a daily basis and understanding underlying payer mindsets and deceptive or misleading denial tactics, my recommendation is never send information to an insurance company until you are asked to do so. And then upon receiving the request, consider what they are asking for and how it applies to what was billed on the claim. (ie make sure documentation supports what is billed.) Also always question any requests made that have nothing to do with the claim already submitted and processed for payment. (ie Refund demands must meet specific compliance requirements which many fail to do, including proper patient notification requirements and appeal rights, etc). By sending an operative note with the claim submittal, keep in mind several things it is likely two different departments handle the claims and review of the op note so you may still have it requested and be required to send it later; Also, by sending the op note with the claim you may be opening a door to unexpected consequences.

 

[lcolborn]

Sending the op reports with the claims for initial transmission in our practice is never been done. We send records when it was asked, and only then you send what is being asked , nothing more.

 

[sls314]

I don't send OP reports on the original submission. I send records when they are requested, and I send only what was requested/what is necessary to get the claim paid.

Would sending an OP report with every CMS-1500 meet the minimum necessary standard for HIPAA compliance?