Wiki New Phys 90 day educational review period

[rogers]

I code for an emergency physician group, and currently our written policy states that any NEW physician to the GROUP is alloted a 90 day educational period where any chart that has missing documentation can be returned to that physician for "educational purposes" so they may learn to document properly. This is written in the compliance plan we have. My question is, does anyone know if Medicare will consider this "leading" if a chart is sent back for additional documentation in order to obtain the proper level. Any advice or thoughts are appreciated.

 

[jimbo1231]

Chart Returns

I don't know of any specific guideline from Medicare. But from what I've seen there are two key issues. One is how the return is worded. If the wording at all looks like the physician is being pushed to a higher level eg you could get to a 99285 if you add the 4th HPI, would be a compliance concern. The other issue is timing. The longer you give the physician to fix the chart the worse it looks.
Generally, in most cases in our field, charts are retuned post coding for educational purposes unless the chart is completely unbillibe as is. There are a couple of entities that do return pre billing; but they are very careful with wording and timing of the return.
Maybe the safest approach is to require new docs or residents attend an inservice when they join the group with several educational follow ups based on their coding.

Jim Strafford CEDC MCS-P