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Compliance

  1. Default Compliance
    Exam Training Packages
    Can anyone tell me if a physician can go back and change the office note to accomodate the patient's complaint about the wrong diagnosis after they realized the claim was denied by the insurance company?

    I'm trying to locate something in writing to give to the providers at my location.

    Thank you

  2. #2
    Default
    If the note was incorrect the doctor can do an amendment stating what was incorrect and why.

    If they are just wanting to change it to get insurance to pay and make the patient happy, then no, they can't do that. That is fraud.

    Not everything is a coding problem. Some rejections are benefit issues and the providers need to stand behind what they did and documented if it is correct regardless of the financial impact.

    Laura, CPC, CPMA, CEMC

  3. #3
    Location
    Greeley, Colorado
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    Well said Laura! I couldn't agree more!
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Default
    look under CMS manual E&M- docuementation guidelines.

  5. Default Compliance
    Criminal False Claims Act...Health Care Fraud (18 US Code 1347) would be a great reference tool. If the addendum misrepresents the previously documented reason and findings for the visit this would be considered fraudlent pretenses therefore subject to fines and imprisonment. When I have a stubborn provider this is usually what I provide to get my point across.
    Cindy

  6. Default
    Thank you all for your responses and resources!

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