Wiki Physician Hospital Billing

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Pia

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Ogden Utah
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HELP!
Our physicians go to the local hospitals to see newborns and they admit and visit sick children as well. They fill out a form with date of service and CPT code to alert us, billing. We then request chart notes from the hospitals and make sure our physicians have documented the visit before we actually code and bill. Getting the documentation can take a long time and it's been suggested that we start billing from the sheets before we get the documentation. I am not comfortable with this and like to hear others thoughts on it. Do you bill hospital charges for a physician before you get the documenetation?
Thanks all.
Pia
 
In the past, we have always just billed from the physician's billing sheet. Of course, spot checking the documentation is always recommended. If you have done training with your providers, chances of a hospital note missing should be slim. As always, you need to do what you are comfortable with but it really slows down the billing process if you have to wait on the documentation. All the years we billed, we rarely, if ever, have had an issue.
 
I trained my pediatrician to take a blank HCFA form as a billing sheet and fill in the pertinent details. If he could get a face sheet, so much the better. But he would pencil in the diagnosis and CPT code with notes to himself on medical conditions. Saved a lot of time on waiting for hospital records and we never had any issues.
 
I disagree with coding from anything less than the documentation. The codes must reflect what is documented, if you do not have the note how can you be certain your codes are correct.
 
That is where a review comes into play and education for your providers. Our providers had E/M training at least once a year and then were reviewed quarterly by the compliance department. I understand , if you are a smaller practice, this may not be possible. A prospective review would be practical in this situation. What wasn't stated is how often when codes were compared against documentation were the providers incorrect in the past? If there was a high rate of error then taking the time to educate the providers can make all the difference in the world and help the billing department feel more comfortable with billing directly from the providers billing sheets.
 
Just wanting to play the devils advocate but why do you need to educate the provider on coding at all. Coding is suppose to be a coder function. The provider is suppose to diagnose and treat and document what was done. If the coder does not read every note then how can they code? We can not should not depend on the provider to give accurate codes since it is not their job.
 
I agree with that statement about coding however; I do feel providers need to have education about coding regardless of whether they are selecting their own codes for billing or a coder is coding their documentation for billing. The question was asked about billing from a physicians sheet, two very different questions. If this is strictly from a billing stand point, and a practice is waiting to verify the provider documented the visit, there good be a significant lag in the billing process. If they are in fact coding the visits for the providers, then waiting would be required. I still stand by educating your providers because ultimately it is their license and their responsibility to ensure what is documented and coded is correct.
 
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