Wiki Internal Audits and Provider Documentation

stephsaylor30@yahoo.com

Networker
Local Chapter Officer
Messages
32
Location
Franklin, OH
Best answers
0
I have a question about internal chart audits and provider documentation. Two of my providers have asked that if I notice a discrepancy between the E/M level they have selected and the E/M level I feel is supported by their documentation that I notify them prior to changing the code so they can "fix" their note. In other words, they want the opportunity to add documentation to support billing 99214 rather than 99213. I am incredibly uncomfortable with this. It's my understanding that amendments can only be added to clarify or correct conflicting documentation, and that amendments made to support a higher code may be considered fraudulent. I am unable to find any authoritative guidelines to support my point of view. Can you offer any insight or resources into how the governing bodies (CMS, OIG) may view such amendments? Thanks in advance.
 
I have a question about internal chart audits and provider documentation. Two of my providers have asked that if I notice a discrepancy between the E/M level they have selected and the E/M level I feel is supported by their documentation that I notify them prior to changing the code so they can "fix" their note. In other words, they want the opportunity to add documentation to support billing 99214 rather than 99213. I am incredibly uncomfortable with this. It's my understanding that amendments can only be added to clarify or correct conflicting documentation, and that amendments made to support a higher code may be considered fraudulent. I am unable to find any authoritative guidelines to support my point of view. Can you offer any insight or resources into how the governing bodies (CMS, OIG) may view such amendments? Thanks in advance.
Good morning. If you do not receive a response on this in the next few days, I would recommend reaching out to your regional NAB member. They will be able to get an answer for you.
 
Top