Wiki Reviewing all vs some chart notes

dcandello

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Hello! I have a question to pose that is more to help me explain to my clinic manager why I have to review all chart notes as opposed to a certain percentage. My manager asked me why I review all chart notes of all my providers before signing off on the charge if it’s correct. She asked why I don’t review a percentage like 25% and just sign off on the rest without looking at/reviewing the chart note. Can someone help me answer this in a way a person with no coding experience would understand?
 
I think your manager asks a good question, and the answer you give is going to depend on what you are seeing when you do these reviews. For example, if you are seeing a very high error rate in the charges and are having to make many corrections to the coding, then reviewing all of the chart notes would be important for both compliance and reimbursement purposes. However, if you are finding that most or all of the charges are correct and you are simply 'signing off', then I would also be asking whether or not it is really a good investment of time to be reviewing every one.

Most organizations, especially larger ones, do not want coders reviewing every note because, quite simply, it is a very costly use of resources to pay coders to review things that don't need reviewing. So practices will set up audit programs where samples of notes are reviewed regularly, and when problems are identified, or it is noted that specific providers or clinics have high error rates, then coders focus on those areas that need their attention, both in terms of reviewing coding for accuracy, as well as in conducting education for those clinics and providers so that, whenever possible, those areas may be able to get to a level where they no longer require 100% review of notes. Areas that have higher rates of error, or for which errors may have a high financial impact, should have higher rates of review. Areas where errors are infrequent or have minimal impact can safely be reviewed at a lower frequency.

So I'd recommend discussing this with your manager from this perspective - let your manager know what you're seeing that supports a high rate of reviews, but also consider opportunities where some charts may not need reviews so that your coding skills can be redirected in a way that will help support the practice's financial health going forward. Hope this may help some.
 
I hope this helps. When I first started coding our company did not think reviewing every note was necessary either. I complained to my boss several times that the codes that the doctors were picking were incorrect, significantly. The company brought in outside auditors/coders and every single doctor failed their audit! The company realized that if an insurance company reviewed our medical records they could ask for their money back on every single office visit. We were at a high risk of paying fines and penalties for the way the physicians were coding. Because the doctors failed their audit so badly, I was given total control over every code that was billed out from then on and we immediately switched to reviewing every chart. A couple of years later if a doctor was really good at choosing their codes, we did not review them for a month. Guess what? The second the doctors knew someone was not reviewing every single chart they fell back to their old habits again! So we went back to coding and reviewing every single chart because we learned that you have to. Show your manager this post, don't make the same mistakes that we did and expose your company to fines and penalties like we did.
 
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