Hello All,
I have a situation in our practice relating to denials based on diagnosis. Many of you have surely experienced upset patients calling stating their bill wasn't paid because, according to the insurance company, the wrong code was used. Our compliance department has advised us that changing the diagnosis or LOS to a denied claim either to obtain payment or avoid pt responsibility, i.e., deductibles, co-insurance, is fraud. Does anyone have experience with this and/or documentation,from Medicare/CMS to support this policy?
Any direction would be greatly appreciated.
Thank You.
I have a situation in our practice relating to denials based on diagnosis. Many of you have surely experienced upset patients calling stating their bill wasn't paid because, according to the insurance company, the wrong code was used. Our compliance department has advised us that changing the diagnosis or LOS to a denied claim either to obtain payment or avoid pt responsibility, i.e., deductibles, co-insurance, is fraud. Does anyone have experience with this and/or documentation,from Medicare/CMS to support this policy?
Any direction would be greatly appreciated.
Thank You.