Hi Everyone, first time posting, so hopefully this is the proper thread!
I work for a company that does billing, coding and collections for outpatient surgery centers (ASC). We are increasingly running into problems where our coding of operative reports does not match up with how the surgeon's office codes their professional claims. The surgery center administrators get frustrated when our codes don't pay as much as they expected (based on what the doctor said he would perform). It is our policy to code only what is documented, so we then have to ask physicians to re-dictate or add an addendum to their operative report, stating that they actually performed the service that they so adamantly claim they did (and billed for!).
We run into this issue for services ranging from pain injections to full joint replacements. We have to explain to administrators, physicians and even patients that we can only bill for what is dictated in the body of the operative report. Yet we are getting more and more push back and or flat out refusals to re-dictate, leaving us with either a low or non-paying CPT, unless we 'take their word' that the service they claim was actually performed.
Has anyone experienced this and had success in explaining to physicians why it is so important that they dictate exactly what was done? Short of providing them a template of common surgery dictations, how can we get them to be more specific?
**I'm not asking about specific cases because this is an issue we experience for all kinds of procedures. I am looking for a better way to explain to a physician why it's so important that they are specific in their reports. Better yet would be some kind of 'official' documentation that explains why they should be doing it, as obviously billing what isn't documented leaves them open to audits and refunds!**
I work for a company that does billing, coding and collections for outpatient surgery centers (ASC). We are increasingly running into problems where our coding of operative reports does not match up with how the surgeon's office codes their professional claims. The surgery center administrators get frustrated when our codes don't pay as much as they expected (based on what the doctor said he would perform). It is our policy to code only what is documented, so we then have to ask physicians to re-dictate or add an addendum to their operative report, stating that they actually performed the service that they so adamantly claim they did (and billed for!).
We run into this issue for services ranging from pain injections to full joint replacements. We have to explain to administrators, physicians and even patients that we can only bill for what is dictated in the body of the operative report. Yet we are getting more and more push back and or flat out refusals to re-dictate, leaving us with either a low or non-paying CPT, unless we 'take their word' that the service they claim was actually performed.
Has anyone experienced this and had success in explaining to physicians why it is so important that they dictate exactly what was done? Short of providing them a template of common surgery dictations, how can we get them to be more specific?
**I'm not asking about specific cases because this is an issue we experience for all kinds of procedures. I am looking for a better way to explain to a physician why it's so important that they are specific in their reports. Better yet would be some kind of 'official' documentation that explains why they should be doing it, as obviously billing what isn't documented leaves them open to audits and refunds!**