Wiki documentation after claim submittal

[shofner14]

I just read an article in the march 2016 edition of healthcare business monthly called Fight for Insurance Carrier Payment. It states that changes should not be made to documentation
after the original claim is filed. Why? Is it to reduce the risk of being accused of fraudulent billing? My practice's billing department received a workers compensation denial for billing 99215
for lack of medical necessity. The physician made an update (addendum) to documentation after the original claim was filed and then an appeal was submitted. Should an additional document (like a letter)
have been submitted w/out making a documentation update w/the appeal to support medical necessity instead?

 

[mitchellde]

I just read an article in the march 2016 edition of healthcare business monthly called Fight for Insurance Carrier Payment. It states that changes should not be made to documentation
after the original claim is filed. Why? Is it to reduce the risk of being accused of fraudulent billing? My practice's billing department received a workers compensation denial for billing 99215
for lack of medical necessity. The physician made an update (addendum) to documentation after the original claim was filed and then an appeal was submitted. Should an additional document (like a letter)
have been submitted w/out making a documentation update w/the appeal to support medical necessity instead?

The claim is treated as an attestation that information on the claim reflects the encounter as documented. You cannot after a denial go into the documentation to change what the original coding was based on. Yes it is a form of fraud to do this.

 

[CodingKing]

Addendum is not acceptable after denial. You can always re-review was was initially attested to and recode the correct level