Wiki Question

[araceli.tinta@gmail.com]

Hi everyone,


I'm new to hospital billing and came across a situation I'm unsure how to handle.


One of our providers submitted a fee ticket indicating a specific procedure was performed. However, when I reviewed the operative report, it doesn’t support the procedure listed on the fee ticket. I also obtained a delivery note (which reflects what was requested/prepared for), and it does match what the provider listed on the fee ticket.


I confirmed with the provider that the fee ticket is what they intended to bill for. However, since the operative report doesn’t support the code, I'm hesitant to bill it.


My understanding is that we must bill based on documentation in the medical record (operative report), not just on what was intended or listed on the fee ticket. Would it be appropriate in this case to ask the provider to amend the operative report if something was left out? Or should I only bill what’s currently documented?


Would love to hear how others handle this kind of discrepancy. Thank you!

 

[info@revantagehbs.com]

You are correct in your understanding. Billing must be based on what is documented in the operative report, not the fee ticket or intent.


The best approach is to query the provider and request an addendum if something was performed but not documented. If no update is made, then only bill what is supported in the record.