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Incomplete Documentation

  1. #1
    Default Incomplete Documentation
    Medical Coding Books
    I'm currently coding for an Ortho group. Documentation from these providers is scarce. Just came across a record dated back to Sept 2010 which is missing the entire plan yet shows electronically signed by the MD. I'm tired of seeing this and sending stuff back to this MD. Recent stuff, fine. Ancient stuff, really?? At what point in time do you all draw a line in the sand and void the charge and initiate a refund to the insurance?

    Thanks,
    Last edited by kmonte; 05-20-2011 at 03:38 PM. Reason: spelling

  2. #2
    Default
    surgries are being submited before review of? oh my

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    After a claim has been sent and then paid or even denied, you cannot have a provider now get the documentation togerther to support the claim. These should be reviewed prior to submission and now especialy since you know they routinely do NOT have the documentation. A claim should never be submitted until the documentation is reviewed and the codes on the claim are indeed supported by the documentation.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default Thanks
    I just cringe each time I see stuff like this. I guess I'm at the point where instead of continuing this 'fight', I kind of want to throw in the towel and part ways. But I'm not a quiter. I'm almost 3 months into this and at times feel like we are making positive strides but then, I hit multiple brick walls all over again. Do you guys have any thoughts or been in a similar situation? How long did you continue the struggle before cutting your losses?

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Do you not review the chart note notes prior to claim submission? If not then why not, and can that process change. If they cannot allow you to perform your job correctly then I say thrown it in, throw it down, and walk away!

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Currently, I and the other coder on staff, and past coders which have 'retired' early, have felt this to be a gloried data entry position. I've tried to remain optimistic but as the days drag on, so does my energy. The individual who was to be our 'leader' out of this muck may be knowledgeable however has lost much respect for her arrogance. This has really componded the dilemna. Even though she keeps reassuring us that things will change, there continue to be so many things that are completely amiss. This is a great place to work BUT we have so far to go!

    I just lost it today and needed some reaffirmation that this is an abnormal situation. I sent that claim back for a refund and voided the charges. It's not documented, it did not happen. I hope that whover reviews refunds at month end will get on the providers over things like this. TGIF! Got lot's to ponder this weekend.

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