This is all good advice. It is situational. As you are advised above, there are many cases where it is appropriate. We can't just use generalized feedback of, "You need to improve your documentation...!" Providers want concrete examples, you need to have reputable sources of information and official guidance and citations for your recommendations. If the documentation is questionable or not enough to code, does your place of employment not have a query process? Are certain providers receiving a higher rate of queries than others? Do certain providers receive more denials for medical necessity (LCD, etc.) and diagnoses than others? Do certain providers have a higher rejection and denial rate overall? Does your practice have regular audits? These are all places to start looking for opportunties for improvement. Most practices or RCM companies have internal data analytics and other reporting systems to analyze this. While it is always good to provide "on the ground" feedback as the person doing the coding, I would suggest following the chain of command or org. chart for bringing concerns. Are you being advised to go directly to a provider with concerns, what is the process for this in your particular company? Do coders have a direct relationship with providers where they are expected to do this themselves? Do you have an audit and education team? Decreasing provider push-back and having meaningful and helpful feedback sessions can be a very delicate process.
A coder or other RCM employee (however well intentioned and especially if NEW) using sweeping generalizations like, "This payer is denying everything!" or "This provider does not document correctly!" or "You need to document better!" is really not helpful. The advice above about bringing concerns (with some specific examples) to a supervisor, manager, CDI team, auditor, etc. is good advice.
Your resources would be the coding guidelines (CPT, ICD, HCPCS, etc.), CPT Assistant, Coding Clinic, LCD, NCD (CMS, etc.), specific payer and contract guidelines for the practice, specialty societies, and other nationally recognized sources.
