Wiki Coding from a hospital list??

Create Wiki
M

medicode3

Networker
Messages
73
Location
Clover, SC
Best answers
0
Good Morning Fellow Coders,
I need some feedback on an issue with coding for physician's and PA's from a hospital list. We have several physician's and PA's on staff where I work. We are still very old school and have to request hardcopy charts in order to code (dx codes...mainly) before we can bill for them. The problem I am having with this is that we have been told in order to save time we should just be using this list to code from (just a list with the pts room #, Phy or PA who saw pt, Patient name, dx/comments & admit date). We have been told that ultimately the phy and/or PA is responsible for correctly adding this information to this "list". I would like to know your opinions about this. I have a VERY HARD time coding from something that I cannot actually see if it is documented in the patient chart.....if the notes have been signed etc. I don't want to lose my credentials. Any suggestions? Thanks :):):)
 
This is exactly what I have been trying to tell them. I wanted to see if I had fellow coders agree with me. :) Thank you
 
Agree, can't code what isn't documented.

Also, if you send a claim to Medicare without the documentation being signed, it is called a false claim and Medicare can deny payment.

I am the only CPC at my office. For years before I got here, they were coding whatever the doctor said was the Pt's dx was. When I started, I flat out refused to do this. (I am a new coder too, have been certified for about 1.5 years now!) I ended up going to the administrator's office and told her that I cannot support billing out hospital claims the way we were doing it and that I had a certification to maintain and I don't want to loose my credentials. (I also told her it was bordering on fraud/abuse, since we knew it was wrong and continued to do so.) I would remind your doctors/practice that Recovery Auditors are really looking into things more now. They are trying to find mistakes in billing, since they get paid a percentage of what they "take back". Do they want to get paid faster and have their money taken back years from now, or do they want to do it right the first time and keep their money?

Also, I would remind them that every time a claim is submitted, their signature is on it. On the back of the 1500 claim form, there is a statement that reads "NOTICE: Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a criminal act punishable under law and may be subject to civil penalties."

Ultimately, they are putting their license on the line as well.
 
You must log in or register to reply here.
Top