Wiki Overdocumented visits!


Albany, OR
Best answers
As a seasoned coder and auditor, I reviewed my husbands documentation from the services he had rendered when he was hospitalized. (He is self pay).
I was SURPRISED that the documentation I reviewed was excessively documented, billed at high level E/M's and he was charged for Critical Care. I was with him the ENTIRE time and he was NOT critical care, and the services which were documented were NOT done.
Therefore, I sent an appeal to the billing office, and outlined why I (I am an authorized representative of my husband) disagree with the charges. I received a response back stating, "That is what was documented, and that is what is billed."
Since he does not have insurance, I really do not know what rights he has as a self pay? Should I request the assistance of our Ombudsman? Anyone have any thoughts, ideas?
Depending on who you heard from at the facility you may consider bumping the issue higher up the chain of command, generally the billing office will send out the generic response you received. I would recommend taking it to the Senior Administrative Staff at the facility, often times you will get a better response and a more detail research effort, especially if you direct it to a specific person. Call the facility and get the same of the director, administration, CEO, etc.

Make sure to include specific area of the documentation that you disagree with; was it the same staff member over documenting or multiple, same type of service, etc. Be detailed and unemotional (facts not feelings) in your letter.

Since you are private pay, then yes, this would be an scenario where your OMSBUDMAN would be of service to you but try the administrator first. Good Luck~