Don't Drop That Claim Yet!

Check for these 4 must-have elements first
Before you submit your next outpatient claim, make sure you're not overlooking any crucial information the insurer needs to reimburse your facility's hard work.
Secure Bare-Bones Minimum

Physician/practitioner order. You're not supposed to provide any tests or services without a physician's order -- but hospital staff file claims for orderless tests and services every day, says Tammye Francis, RHIT, CCS, regional health information management director for Community Health Systems, who presented on outpatient diagnosis coding at the 12th Annual American Academy of Professional Coders Conference in Atlanta. Registration staff shouldn't process the paperwork without an order either.


Diagnosis/reason for test. This tells your intermedi ary why the patient was at your facility.


Patient's demographic information. This data allows you to make sure you're billing the correct insurance company -- the first time around.


Patient's consent for treatment. The patient needs understand fully what his treatment includes, and the benefits and risks involved.

Add Crucial Records for Certain Visit Types

Ambulatory surgery. You not only need the patient's consent for treatment, but also her consent for the procedure, Francis says. Don't forget the operative report, and for some procedures, you'll need to include an anesthesia record.


Emergency room (ER). Documentation for these patients should include their consent for treatment, physician orders for tests and services, encounter records, nursing notes, and medication administration records if necessary. Add records for any additional ER services, such as sutures.


Outpatient therapy (particularly radiation or chemotherapy). "Orders here are critical, especially for chemo patients, because we want to make sure we're getting them the right drugs, at the right doses -- and that we're administering them in the proper time frame," Francis says.


Observation. The most important pieces of documentation for these patients, Francis says, are progress notes that detail the patient's history, tell why he is in observation, and monitor his status. You should also include a final progress note.


- Published on 2004-06-10